Natural history of single vessel disease. Risk of sudden coronary death in relation to coronary anatomy and arrhythmia profile

Abstract

214 patients with single vessel disease were followed-up for 1-78 months (mean 48 months). Incidence of sudden death was studied in relation to coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during ambulatory ECG recording. Incidence of sudden death was 11% (16 of 144) in patients with lesions of the left anterior descending branch (LAD), 8% (4 of 55) in lesions of the right (RCA) and 7% (1 of 15) in those with lesions of the left circumflex (LCX) coronary artery. Coronary artery occlusion was associated with a significantly higher incidence of sudden death (15%, 18 of 123) than high-grade stenosis (3%, 3 of 91) (P less than 0.05). The risk of sudden death increased in patients with complex arrhythmias and occluded LAD or RCA (8 of 38, 21%; 2 of 12, 18%) compared with patients without complex arrhythmias (5 of 34, 15%; 1 of 18, 6%). One patient with LCX occlusion died suddenly. Our data show that the incidence of sudden death in relatively low in patients with single vessel disease. However, there is a high risk of sudden death in patients with LAD or RCA occlusion associated with akinetic left ventricular areas and complex arrhythmias.

Relation of plasma lipoprotein(a) to infarct artery patency in survivors of myocardial infarction.

“…Antegrade perfusion of the infarct artery favorably influences long-term morbidity and mortality: compared with those whose infarct artery is occluded, those with antegrade flow have less left ventricular dilatation,12 improved regional left ventricular performance,10'11 a lower incidence of late potentials by signal-averaged ECG,13'14 and improved survival. [15][16][17] Previous studies have suggested that an imbalance of intrinsic fibrinolytic and prothrombotic activity may be contributory in patients with unstable angina,36 myocardial infarction,18 saphenous vein graft occlusion after bypass surgery,37 and fatal cardiovascular events. 38 However, no study has examined fibrinolytic or prothrombotic activity in survivors of infarction in whom the angiographic status of the infarct artery was known.…”

Models of Major Adverse Cardiac Event Risk Using Results of Exercise Stress Echocardiography With Noninvasive Coronary Artery Flow Assessment in Patients With Ischemic Heart Disease

“…Чаще всего с прогностической целью использовался коронарный резерв ПМЖА, как прави-ло, с учетом наибольшей площади кровоснабжения этой артерии и прогностической значимости при поражении по данным коронарографии ствола левой коронарной артерии или непосредственно ПМЖА [9,13,14]. Дан-ные параметры были исследованы только для тестов с фармакологическими препаратами.…”

A Novel Technique to Detect Total Occlusion in the Right Coronary Artery Using Retrograde Flow by Transthoracic Doppler Echocardiography

“…However, there is a risk of sudden death in patients with LAD or RCA occlusion associated with akinetic left ventricular areas and complex arrhythmias. 30,31 PCI of a CTO is now a well-accepted revascularization procedure, accounting for approximately 10% of patients undergoing PCI. [1][2][3][4][5][6][7][8][9] Resent studies demonstrated that a successfully revascularized CTO significantly improves cardiac survival.…”