Left ventricular function at 3 months after successful thrombolysis. Impact of reocclusion without reinfarction on ejection fraction, regional function, and remodeling.

Meijer, A.; Verheugt, Freek W.A.; Eenige, M. J. van; Werter, C. J. P. J.

doi:10.1161/01.cir.90.4.1706

Cited by 62 publications

(27 citation statements)

References 30 publications

(4 reference statements)

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“…Furthermore, patients without reocclusion dem-L eft ventricular remodeling after acute myocardial infarction, resulting in enlargement of the ven tricle, is a progressive process beginning in the early phase and continuing for months and years.1 -4 It occurs predominantly after a large transmural anterior wall infarction2* 5 and carries an adverse prognosis.6* 7 There are supporting experimental and clinical data that successful reperfusion of the infarct-related artery can prevent this sequela by limiting infarct expansion. [8][9][10] Re cent clinical studies have shown that infarct-related artery patency is one of the most important determinants for ventricular remodeling after myocardial infarction.4*1 U2 Initial success of thrombolysis, however, is followed by reocclusion in almost 30% of patients within 3 months after myocardial infarction.13*14 Reocclusion is associated with a more complicated hospital course,15 impaired short-term recovery of regional and global ventricular function, [15][16] and an increase in end-systolic volume 3 months after myocardial infarction. 16 Long-term data with respect to reocclusion are limited.17 Therefore, the aim of this study was to determine the implications of reocclusion on left ventricular size and function 5 years after first anterior myocardial infarction.…”

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confidence: 99%

“…[8][9][10] Re cent clinical studies have shown that infarct-related artery patency is one of the most important determinants for ventricular remodeling after myocardial infarction.4*1 U2 Initial success of thrombolysis, however, is followed by reocclusion in almost 30% of patients within 3 months after myocardial infarction.13*14 Reocclusion is associated with a more complicated hospital course,15 impaired short-term recovery of regional and global ventricular function, [15][16] and an increase in end-systolic volume 3 months after myocardial infarction. 16 Long-term data with respect to reocclusion are limited.17 Therefore, the aim of this study was to determine the implications of reocclusion on left ventricular size and function 5 years after first anterior myocardial infarction.…”

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confidence: 99%

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Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction

et al. 1997

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Background Successful thrombolysis can prevent left ven tricular dilatation after acute myocardial infarction. However, in almost 30% of patients, reocclusion occurs. The aim of this study was to assess the long-term implications o f reocclusion on left ventricular size and function.Methods and Results Fifty-six patients were studied with two-dimensional echocardiography at baseline (2 ± 1.6 days) and 5.0± 1.4 years after first anterior myocardial infarction. All pa tients (a subset of those enrolled in the APRICOT trial) had a patent infarct-related artery when studied < 4 8 hours after throm bolysis and underwent repeat coronary angiography at 3 months. Baseline characteristics were comparable in patients with (n= 17) and without reocclusion (n=39). Left ventricular volume indexes were stable in patients without reocclusion. Patients with reoc clusion, however, showed a significant increase in end-diastolic volume index (EDVI; P = .008) and end-systolic volume index (ESVI; P=.039). Furthermore, patients without reocclusion dem-

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confidence: 99%

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confidence: 99%

Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction

et al. 1997

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“…These may include reduction of ventricular remodeling, decreased ventricular instability with the resulting diminished incidence of ventricular arrhythmias, and provision of collateral vessels to other territories in the event of further coronary artery occlusion [5][6][7][8][9][10]. In addition to promoting an acute inflammatory response and local edema, reperfusion of IRA with an adequate blood flow at a proper arterial perfusion pressure increases tissue turgor, which may have a scaffolding further reinforced by other reported studies [21][22][23][24][25]. These latter investigations demontrated that late patency of an IRA seems to have a positive influence on remodeling and survival and that this effect is independent of any acute reduction of infarct size secondary to reperfusion during the acute phase of an evolving AMI.…”

Section: Editorialmentioning

confidence: 94%

Long-Term Outcome of Percutaneous Coronary Intervention of a Persistent Total Occlusion in the Infarct-Related Coronary Artery

Centurión¹

2015

JCCR

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Submit Manuscript | http://medcraveonline.com effect on the vulnerable infarcted territory increasing tissue stiffness to possibly resist infarct expansion [6]. All of these changes in the compromized zone should have a beneficial influence on the remodeling process by altering the properties of the scar tissue and by diminishing the ischemic burden in the non-infarcted myocardium at the border zone [5][6][7]. All of these plausible mechanisms should be tested in clinical situation to properly evaluate clinical outcomes. However, caution must be exercise when interpreting the results of studies examining this open artery hypothesis. This hypothesis can be tested in its purest sense in experimental animal models, a setting where almost all the variables are known and controlled. However, the clinical situation is much more complex depending on the extension of damaged, ischemic/necrotic territory. Patients may have acute-onchronic coronary artery occlusion in the presence of multivessel disease and well-developed collateral channels. The pattern of necrosis may also be different with areas of necrosis separated by islands of ischemic, stunned, hybernating, or normal cells [11][12][13]. The random combination of these different variables could have diverse impact on clinical outcomes and events.The role of late opening of the totally occluded infarct-related coronary artery (IRA) after AMI has been controversial. Although there is a large body of experimental and clinical evidence supporting the concept of late PCI for AMI, the mechanism responsible for the observed benefits remain speculative [14][15][16][17][18]. There are observational data suggesting a lower incidence of clinical events, and experimental studies reporting a reduction in adverse left ventricular remodeling after late PCI of a totally occluded IRA. In order to properly test the open artery hypothesis, vessel patency should be assessed days to weeks after AMI and a demonstrable beneficial effect should be independent of early left ventricular (LV) function. This approach will diminish the influence of spontaneous closure of the vessels that were open early post AMI or the spontaneous opening of the vessels that were closed early. White H et al. [19], examined infarct vessel patency and LV function in their patients one month after the first AMI. These two parameters, vessel patency and LV function, were found independently predictive of survival over 3 years of followup on multivariate analysis. They observed that the beneficial effect of a patent vessel was greatest when the IRA supplied more than 25% of the myocardium and the ejection fraction was less than 50%. However, it is very important to state that serial assessment of left ventricular function was not performed. Therefore, the mechanism for the benefit is unclear. In a similar study [20] done in a cohort of 58 patients, infarct-related vessel patency was assessed 7 to 10 days after AMI. In the first week of AMI, left ventricular function was similar in patients with a patent or an occlu...

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“…Analogous to that finding, a reduced risk of reocclusion may not automatically confer improved outcome, especially in a low-risk population. Besides the adverse impact on long-term survival, reocclusion also impairs left ventricular recovery [15]. The lower reocclusion rate in smokers may therefore confer a beneficial effect on remodeling and a lower risk to develop heart failure.…”

Section: Smoking and Clinical Outcomementioning

confidence: 99%

“…Notably, most reocclusions occur without clinical reinfarction [12][13][14]. Even in these cases, reocclusion has adverse impact on recovery of left ventricular function [15]. Previously we have shown that reocclusion is a strong predictor of 10-year cardiac mortality, independent of left ventricular ejection fraction, and even when presenting without signs of reinfarction or recurrent ischemia [16].…”

Section: Introductionmentioning

confidence: 99%

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

Kievit

Brouwer

Veen

et al. 2008

J Thromb Thrombolysis

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Background In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. Methods In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients with an open infarct artery \48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. Results Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P \ 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in nonsmokers (P \ 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05-5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37-0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79-2.25, P = ns). Conclusions After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.

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Left ventricular function at 3 months after successful thrombolysis. Impact of reocclusion without reinfarction on ejection fraction, regional function, and remodeling.

Cited by 62 publications

References 30 publications

Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction

Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction

Long-Term Outcome of Percutaneous Coronary Intervention of a Persistent Total Occlusion in the Infarct-Related Coronary Artery

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

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