THE EFFECT OF LATE REVASCULARIZATION OF T HE CULPRIT ARTERY AFTER INFARCTION ON LEFT-VENTRICULAR FUNCTION AND REMODELING

The effects of late angioplasty of the culprit artery after myocardial infarction on the decisive prognostic factors of left ventricular fun ction and remodeling are not well known. When the culprit artery is na rrowed but patent, angioplasty leads to improvement in segmental contr actility and global left ventricular function : it does not seem to in fluence left ventricular end-diastolic volume. When the artery remains occluded. global and regional left ventricular function is also impro ved when the recanalised artery remains patent. Moreover, restoration of satisfactory artery patency prevents ventricular remodeling whereas in failed angioplasty or reocclusion, there is a progressive increase in left ventricular volume. However, these results observed in unsele cted patients could be improved : it would seem that the different ben eficial effects only occur when there is residual myocardial viability ; in the absence of signs of myocardial viability, the ventricular eff ects of limitations of angioplasty (incidence of restenosis or reocclu sion in this specific context, lower primary success rate in complete arterial occlusion) explain the negativity of rare randomised studies comparing the outcome of left ventricular function depending on whethe r a conventional attitude or systematic revascularisation of the culpr it artery is adopted.