The impact of very late revascularization of occluded infarct-related artery on cardiac mortality and the incidence of sudden death in survivors of acute myocardial infarction -long-term observation.
Maciej Kośmider, Ryszard Jaszewski, Paweł Ptaszyński, Halina Bolińska, Jan Ruta, Krzysztof Jerzy Wranicz, Marcin Rosiak, Janusz Zasłonka
Med Sci Monit 2002; 8(5): CR364-370
BACKGROUND: In survivors of acute myocardial infarction (AMI), an occludedinfarct-related artery (IRA) is an important predictor of cardiac death (CD) and sudden death (SD). Earlyreperfusion of the IRA was associated with improved survival rate. The purpose of the present study wasto assess if late IRA revascularization, performed 10-30 days after AMI, also has a beneficial effecton the incidence of CD and SD during an 18-month follow-up. MATERIAL/METHODS: The study population consistedof 93 post-MI patients with occluded IRA on coronary angiography. The patients were divided into 2 groupsaccording to IRA status at discharge -- revascularized (47 patients) or occluded (46 patients) -- andfollowed. Before revascularization, the two groups of patients did not differ in the prevalence of clinicaland angiographic variables, or in the incidence of risk factors for SD. In patients who underwent angioplastyor bypass graft surgery of closed IRA, the markers of electrical instability demonstrated no significantimprovement after revascularization. RESULTS: During the 18-month follow-up a significantly lower incidenceof CD (0% vs 15%, p<0.01) and SD (0% vs 11%, p<0.03) was observed in the group of patients with revascularized IRA than in the group of patients with occluded IRA.
Conclusions: In survivors of AMI, late reperfusion of occluded IRA is associated with reduced 18-month cardiac mortality. The beneficial effect of this procedure on the incidence of sudden death, not associated with improvement in myocardial electrical stability, suggests that ischemia can be considered an important factor modulating the arrhythmogenic substrate.
Keywords: Adult, Aged, Angioplasty, Transluminal, Percutaneous Coronary, Coronary Artery Bypass, Death, Sudden, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Risk Factors, Time Factors, Treatment Outcome