Adaptive remodeling of the infarct-related artery is associated with recurrent ischemic events after thrombolysis in acute myocardial infarction

Background Recurrent ischemic events occur during the hospital stay of 7-32 % of patients after successful thrombolytic treatment of acute myocardial i nfarction (AMI). Objective To define the association between postinfarction angina pectoris and the clinical, angiographic, and intravascular ultrasound (IVUS) paramet ers of the infarct-related artery for consecutive prospectively included pa tients. Methods Clinical, qualitative, and quantitative angiographic and IVUS data for 64 patients (56 men, aged 53 +/- 12 years) with thrombolysis of AMI wer e analyzed. All patients underwent coronary angiography and pre-interventio nal IVUS measurement electively within 1 month of AMI or at the time of the occurrence of postinfarction angina pectoris, Classification as adaptive o r constrictive remodeling was according to whether the cross-sectional area of a vessel was larger or smaller than that of the proximal or distal refe rence segment. Results Nineteen of the 64 patients (29.7%) suffered from recurrence of isc hemic events (group 1), whereas 45 patients (60.3%, group 2) remained free from symptoms. In univariate analyses, multivessel disease (42 versus 24%, P = 0.0236) and adaptive remodeling (63 versus 24%, P = 0.0032) were found to occur more commonly among patients in group 1. The patients in group 1 e xhibited larger total vessel cross-sectional areas than did the patients in group 2 (17.5 +/- 4.2 versus 14.9 +/- 6.1 mm(2), P = 0.0556). In multivari ate regression analysis, adaptive remodeling proved to be a significant pre dictor (P = 0.0145) of the recurrence of ischemic events after thrombolysis of AMI. Conclusions Adaptive remodeling of the infarct-related artery is associated with early postinfarction angina pectoris after thrombolysis of AMI. Coron Artery Dis 12:167-172 (C) 2001 Lippincott Williams & Wilkins.