Coronary Recanalization by Elective Angioplasty Prevents Ventricular Dilation After Anterior Myocardial Infarction

Pizzetti, Giuseppe; Belotti, Giuseppina; Margonato, Alberto; Cappelletti, Alberto; Chierchia, Sergio

doi:10.1016/s0735-1097(96)00276-8

Cited by 70 publications

(31 citation statements)

References 37 publications

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“…We expected that primary PTCA would have a beneficial effect even for late-entry patients. A previous report 9 demonstrated that late mechanical opening of the IRA had beneficial effects on LV remodeling. However, no previous studies had demonstrated long-term beneficial clinical effects.…”

Section: Horie Et Al December 1 1998mentioning

confidence: 91%

“…6,7 Recently, Sabri et al 8 demonstrated a high initial success rate, a low complication rate, and a low incidence of reocclusion by late PTCA in a nonrandomized trial. In addition, Pizzeti et al 9 reported beneficial effects of "very late" (2 weeks after myocardial infarction [MI]) mechanical reperfusion of the IRA on left ventricular (LV) remodeling. Hochman,10 in an editorial comment on the Pizzeti report, evaluated the beneficial effects of late PTCA for occluded IRA after anterior MI but stated that a randomized trial was necessary.…”

mentioning

confidence: 99%

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Long-Term Beneficial Effect of Late Reperfusion for Acute Anterior Myocardial Infarction With Percutaneous Transluminal Coronary Angioplasty

et al. 1998

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Background-Although the short-term and long-term beneficial effects of early coronary revascularization by primary PTCA or thrombolytic therapy have been established for acute myocardial infarction, thrombolytic therapy Ͼ24 hours after the onset of acute myocardial infarction has not been shown to improve clinical outcome. The purpose of this study was to assess the effect of late revascularization by primary PTCA over a 5-year period. Methods and Results-Eighty-three patients with initial Q-wave anterior myocardial infarction Ͼ24 hours after onset were randomized into a PTCA group (nϭ44) and a no-PTCA group (nϭ39). Long-term follow-up was conducted with regard to end points, which included cardiac death, nonfatal recurrence of myocardial infarction, and development of congestive heart failure. Left ventricular ejection fraction and regional wall motion at 6 months after myocardial infarction were similar in the 2 groups. Left ventricular end-diastolic and end-systolic volume indexes were significantly smaller in the PTCA group than in the no-PTCA group (PϽ0.0001). With cardiac events as end points, a 5-year Kaplan-Meier event-free survival analysis revealed that the no-PTCA group had a worse prognosis than the PTCA group (PϽ0.0001). Patency of the infarct-related artery, left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were significantly associated with cardiac events by a Cox proportional hazards analysis (hazard ratios 0.120, 0.845, 1.065, and 1.164, respectively). Conclusions-In initial Q-wave anterior myocardial infarction, we conclude that even with late reperfusion, PTCA had beneficial effects on cardiac events over the 5-year period after myocardial infarction, with the prevention of left ventricular dilation after myocardial infarction being a possible mechanism. (Circulation. 1998;98:2377-2382.)

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Section: Horie Et Al December 1 1998mentioning

confidence: 91%

mentioning

confidence: 99%

Long-Term Beneficial Effect of Late Reperfusion for Acute Anterior Myocardial Infarction With Percutaneous Transluminal Coronary Angioplasty

et al. 1998

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“…17 Dilation portends a poor long-term outcome. Prior evidence for an association between persistent IRA occlusion and late-phase LV remodeling, 18 characterized by increased contractile segment length and change in shape toward the spherical, 19 is more robust than the evidence for the association of IRA status and global LV systolic function. The present trial was able to assess the effect of late PCI of an occluded IRA on LV remodeling only as a secondary end point and only in a subgroup of patients selected on the basis of technical features of the LV angiogram and on patient compliance with the second catheterization.…”

Section: Džavík Et Al Total Occlusion Study Of Canada-2mentioning

confidence: 96%

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

et al. 2006

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Background-In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function. Methods and Results-Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (nϭ332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy-only patients had a patent IRA (PϽ0.001). LV ejection fraction increased significantly (PϽ0.001) in both groups, with no between-group difference: PCI 4.2Ϯ8.9 (nϭ150) versus medical therapy 3.5Ϯ8.2 (nϭ136; Pϭ0.47). Median change (interquartile range) in LV end-systolic volume index was Ϫ0.5 (Ϫ9.3 to 5.0) versus 1.0 (Ϫ5.7 to 7.3) mL/m 2 (Pϭ0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (Ϫ8.2 to 13.3) versus 5.3 (Ϫ4.6 to 23.2) mL/m 2 (Pϭ0.07) in the PCI (nϭ86) and medical therapy-only (nϭ76) groups, respectively. Conclusions-PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI. (Circulation. 2006;114:2449-2457.)

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“…Although peak CPK levels were highest among Malay patients, suggesting larger infarctions, the absolute variations were small and unlikely to be clinically significant, 20 and differences persisted after statistical adjustment. Information on heart failure was not available.…”

Section: Discussionmentioning

confidence: 81%

Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction

Mak¹,

Kark²,

Chia³

et al. 2004

Clinical Cardiology

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SummaryBackground: Ethnic differences in coronary mortality have been documented, and South Asians from the Indian subcontinent are particularly vulnerable.Hypothesis: This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long-term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore.Methods: All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project. Information on utilization of coronary angiography, coronary angioplasty, coronary artery bypass graft, and survival was obtained by data linkage with national billing and death registries. Hazard ratios (HR) were calculated using the Cox proportional hazards model with adjustment for baseline characteristics.

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Coronary Recanalization by Elective Angioplasty Prevents Ventricular Dilation After Anterior Myocardial Infarction

Abstract: Delayed PTCA of an occluded LAD can frequently restore vessel patency. Success appears to be associated with better ventricular function and a lack of chronic dilation. Large randomized studies are warranted to evaluate the effect of delayed PTCA on late mortality.

Cited by 70 publications

References 37 publications

Long-Term Beneficial Effect of Late Reperfusion for Acute Anterior Myocardial Infarction With Percutaneous Transluminal Coronary Angioplasty

Long-Term Beneficial Effect of Late Reperfusion for Acute Anterior Myocardial Infarction With Percutaneous Transluminal Coronary Angioplasty

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction

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