Biomedical subjects

K N Garratt

Publications and source records attributed to K N Garratt.

At least 37 records · Page 2Linked to original sources

PubMed1999

Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction.

OBJECTIVES: The purpose of this study was to examine the impact of sulfonylurea drug use on outcome in diabetic patients undergoing direct coronary angioplasty for acute myocardial infarction. BACKGROUND: Sulfonylurea drugs impair ischemic preconditioning. Whether sulfonylurea drugs affect outcome adversely in diabetic patients undergoing direct angioplasty for acute myocardial infarction is unknown. METHODS: Clinical outcomes after direct balloon angioplasty for acute myocardial infarction were evaluated in 67 diabetic patients taking oral sulfonylurea drugs and 118 diabetic patients not taking these drugs. RESULTS: Hospital mortality was significantly higher among diabetics treated with sulfonylurea drugs at the time of myocardial infarction (24% vs. 11%). Univariate analysis identified sulfonylurea drug, age, ventricular function, ejection fraction less than 40%, prior bypass surgery and congestive heart failure as correlates of increased in-hospital mortality. Logistic regression found sulfonylurea drug use (odds ratio 2.77, p=0.017) to be independently associated with early mortality. Congestive heart failure, but not sulfonylurea drug use, was associated with an increased incidence of in-hospital ventricular arrhythmias. Congestive heart failure, prior bypass surgery and female gender, but not sulfonylurea drug use, were associated with late adverse events. CONCLUSIONS: Sulfonylurea drug use is associated with an increased risk of in-hospital mortality among diabetic patients undergoing coronary angioplasty for acute myocardial infarction. This early risk is not explained by an increase in ventricular arrhythmias, but may reflect deleterious effects of sulfonylurea drugs on myocardial tolerance for ischemia and reperfusion. For surviving patients sulfonylurea drug use is not associated with an increased risk of serious late adverse events.

Adult↗

PubMed1999

The influence of abciximab use on clinical outcome after aortocoronary vein graft interventions.

OBJECTIVES: The purpose of this study was to evaluate the effect of abciximab use on clinical outcome in aortocoronary vein graft interventions. BACKGROUND: Although large randomized trials have demonstrated a significant benefit of abciximab use in the setting of percutaneous coronary interventions, there is relatively little data with respect to the use of this agent in percutaneous vein graft interventions. METHODS: Three hundred and forty-three patients were identified; 210 undergoing vein graft intervention without abciximab and 133 patients with abciximab. RESULTS: There were differences in baseline clinical and angiographic characteristics between the two groups; advanced age, unstable angina, older vein grafts and thrombus containing lesions were relatively common in both groups. Angiographic and procedural success rates were similar with or without the use of abciximab (89% vs. 92%, p = 0.15, and 85% vs. 91%, p = 0.12, respectively). The in-hospital composite end point of death/Q-wave myocardial infarction (QWMI)/repeat revascularization was similar between the two groups. Utilizing statistical modeling to adjust for baseline differences between the groups, abciximab use did not influence the cumulative long-term composite end point of death/MI/repeat revascularization. CONCLUSIONS: This study demonstrates that in this relatively high-risk population undergoing aortocoronary vein graft interventions, the administration of abciximab periprocedurally does not appear to reduce major adverse clinical events.

Abciximab↗

PubMed1999

Nothin' but 'net?

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Cardiac Catheterization↗

PubMed1999

Staphylococcus lugdunensis endocarditis: a complication of vasectomy?

Three cases of Staphylococcus lugdunensis endocarditis have been reported in patients with a history of vasectomy preceding the development of endocarditis. We describe a new case of a 39-year-old man who developed infective endocarditis due to S. lugdunensis after vasectomy. He was successfully treated with a 7-week course of intravenous antibiotics and subsequently underwent mitral valve reconstruction for severe mitral regurgitation. The present case further supports an association between vasectomy and S. lugdunensis endocarditis.

Adult↗

PubMed1999

Sensible technology.

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Blood Vessel Prosthesis Implantation↗

PubMed1998

Abciximab administration and outcome after intracoronary stent implantation.

Although adjunctive abciximab therapy improves outcome after angioplasty or atherectomy, there are few data demonstrating its benefit for intracoronary stent implantation. We characterized patients receiving abciximab for stent placement in our practice and determined the impact of abciximab on outcome. Abciximab was introduced to our practice in April 1995 for percutaneous revascularization. Demographic, clinical, and angiographic variables that were independently associated with the use of abciximab for stent placement through 1996 (abciximab era) were examined. We then examined among all patients receiving stents from 1992 through 1996 (preabciximab and abciximab eras) whether the use of abciximab was independently associated with improved outcome (death, nonfatal Q-wave myocardial infarction, coronary bypass surgery, or target vessel percutaneous revascularization) in the hospital and at 30 days. The 30-day event rate was 7% for those who did or did not receive abciximab. The following characteristics were independently associated with the use of abciximab for stent placement in the abciximab era: thrombus before stent placement (chi-square 50.5), > or =2 stents implanted (chi-square 10.8), stent in venous graft (chi-square 7.4), calcific lesion (chi-square 5.8), and hypertension (chi-square 5.5). Among all patients receiving stents in the preabciximab and abciximab eras (n=1,859), the presence of these characteristics was independently associated with worse outcome. Abciximab, however, did not improve outcome in the hospital (odds ratio [95% confidence interval]=0.96 [0.58 to 1.58]) or at 30 days (0.87 [0.53 to 1.41]), even after adjusting for these characteristics. Abciximab for stent placement was used in high-risk patients in our practice but was not associated with improved outcome.

Abciximab↗

PubMed1998

Rotational atherectomy for bifurcation lesions of the coronary circulation: technique and initial experience.

Bifurcation lesions of the coronary circulation are difficult to treat with standard balloon technology and are associated with relatively low procedural success rates and high complication rates. We hypothesized that effective debulking of bifurcation lesions with rotational atherectomy would improve observed results. Fifteen patients underwent rotational atherectomy of such lesions. Both limbs of the bifurcation were rotablated in seven patients and one limb in eight; seven patients also underwent stent deployment. Successful angiographic results were obtained in all limbs (<30% residual stenoses). One patient had a non-Q-wave myocardial infarction. No other significant complications occurred. We conclude that rotablation of bifurcation coronary stenoses is feasible, safe, and associated with a high likelihood of angiographic success.

Aged↗

PubMed1998

Clinical outcome of patients undergoing multivessel coronary stent implantation.

OBJECTIVES: To evaluate the outcome of patients undergoing multivessel coronary stent implantation. BACKGROUND: Percutaneous transluminal coronary angioplasty has been shown to be an effective treatment for multivessel coronary artery disease, although the need for repeat revascularization continues to be a limitation. Intracoronary stent placement has been shown to reduce the need for subsequent revascularization. METHODS: Seventy-seven patients without prior coronary artery bypass grafting (CABG) undergoing multivessel coronary revascularization in which stents were placed in all treated segments over a 5 year period at our institution were identified. Clinical and angiographic characteristics and outcomes were analyzed. RESULTS: One hundred and eighty-eight coronary lesions were successfully treated (2.1+/-0.3 treated vessels/patient, 2.4+/-0.6 treated lesions/patient) using 2.8+/-1.2 stents/patient (range 2-9) and 1.4+/-0.8 stents/vessel (range 1-6). Procedural success rate [angiographic success without in-hospital death, Q-wave myocardial infarction (Q-wave MI) or CABG] was achieved in 76 of 77 patients (98.7%). Anatomically complete revascularization was achieved in 46 (59.7%) patients. Modified ACC/AHA Type B2 and C lesions comprised 75.5% of the 188 lesions. The left anterior descending artery was treated in 57 (74.0%) patients. The indication for stent placement was dissection or threatened/abrupt closure in 54 segments (28.8%). In-hospital events included death in one patient (1.3%); no patient suffered a Q-wave MI or required CABG. Stent occlusion occurred in two (2.6%) patients, and repeat percutaneous intervention of the target vessel was also required in these two patients. Any of these adverse events occurred in three (3.9%) patients. No further events occurred after hospital discharge in the 30 days after the procedure. Of hospital survivors (n=76), adverse events at 6 months included death in two patients (2.6%), MI in two (2.6%), CABG in six (7.9%); nine (11.8%) patients underwent repeat percutaneous intervention and 15 (19.7%) underwent any revascularization. CONCLUSIONS: Multivessel coronary stent placement is associated with an excellent procedural success rate despite a high rate of adverse lesion characteristics, and a low rate of death or MI during follow-up. The need for further revascularization compares favorably with published rates with multivessel PTCA and single stent implantation for discrete de novo lesions.

Aged↗

PubMed1998

Intravenous adenosine and lidocaine in patients with acute myocardial infarction.

OBJECTIVES: A pilot study was designed to assess the safety of combined intravenous adenosine and lidocaine in patients with acute myocardial infarction and to estimate the likelihood of a beneficial effect on final infarct size. BACKGROUND: Adenosine plus lidocaine reduces infarct size in animals, but the safety and efficacy in human beings is unknown. METHODS AND RESULTS: Adenosine (70 microg/kg per minute intravenous infusion) plus lidocaine (1 mg/kg intravenous bolus injection and 2 mg/kg per minute infusion) was given to 45 patients with acute myocardial infarction. Patients underwent immediate balloon angioplasty without preceding thrombolytic therapy. Myocardial perfusion defects were measured with serial technetium 99m sestamibi studies. One patient developed persisting hypotension in conjunction with a large inferolateral myocardial infarction. Transient hypotension in three other patients resolved with a reduction in adenosine. Advanced atrioventricular block was never observed. Other adverse events (including atrial fibrillation, ventricular tachyarrhythmia, bradycardia, and respiratory distress) occurred at low frequencies, as expected for patients with acute myocardial infarction. An initial median perfusion defect of 45% of the left ventricle (60% for anterior infarction, 17% for nonanterior infarction) was observed. At hospital discharge (mean +/- SD = 4.3 +/- 2.1 days) the median value was 12%, and at 8 +/- 4 weeks it was 3% (7% for anterior infarction, 0% for nonanterior infarction); 14 patients had no measurable follow-up. Compared with historical control patients, prehospital discharge measurements were not different but late perfusion defects were improved. CONCLUSIONS: Treatment with intravenous adenosine and lidocaine during acute myocardial infarction has sufficient safety and potential for improved myocardial salvage. Randomized studies are justified.

Adenosine↗

PubMed1998

Predictors of smoking cessation after percutaneous coronary revascularization.

OBJECTIVE: To identify factors predictive of smoking cessation after successful percutaneous coronary revascularization. MATERIAL AND METHODS: We undertook a case-control study of the smoking status of all patients at Mayo Clinic Rochester from September 1979 through December 1995 who were smokers at the time of an index percutaneous coronary revascularization procedure in the non-peri-infarction setting (no myocardial infarction within 24 hours). Maximal duration of prospective follow-up was 16 years. Patients were classified into those who permanently quit smoking immediately after the procedure (N = 435; mean follow-up, 5.1 +/- 3.7 years) or those who continued to smoke at some time during follow-up (N = 734; mean follow-up, 5.3 +/- 3.7 years). Logistics regression models were formulated to determine independent predictors of smoking cessation. RESULTS: Predictors of continued smoking were greater prior cigarette consumption (odds ratio [OR] = 1.009 for each pack-year; 95% confidence interval [CI] = 1.004 to 1.014) and having one or more risk factors for coronary artery disease other than cigarette smoking (OR = 1.49; 95% CI = 1.15 to 1.93). Older age (OR = 0.98 for each additional year; 95% CI = 0.97 to 0.99) and unstable angina at time of initial assessment (OR = 0.69; 95% CI = 0.52 to 0.91) were associated with less likelihood of continued smoking. CONCLUSION: Younger patients with a worse risk profile and greater prior cigarette consumption were more likely than other patients to continue smoking after percutaneous coronary revascularization in the non-peri-infarction setting. Patients who had unstable angina were more likely to quit smoking than those who had stable angina. Despite the proven benefits of smoking cessation after percutaneous coronary revascularization, a substantial proportion of smokers (63%) continue to smoke; thus, smoking-cessation counseling should be addressed in this population.

Aged↗

PubMed1997

Outcome > or = 10 years after successful percutaneous transluminal coronary angioplasty.

Patients (n = 611) after successful percutaneous transluminal coronary angioplasty were prospectively followed over 10 to 16 years for major adverse events. The effect of gender, extent of coronary artery disease, left ventricular dysfunction, and age on occurrence of adverse events were analyzed in detail. The incidence of death, Q-wave myocardial infarction, and coronary bypass surgery was 23.1%, 3.9%, and 32.7%, respectively. Men and women had similar mortality (p = 0.13) and Q-wave myocardial infarction (p = 0.57), but men had more coronary bypass surgery (p = 0.06). Patients with multivessel disease had higher mortality (p < 0.0001), and patients with 3-vessel disease had a higher incidence of Q-wave myocardial infarction (p = 0.04) and coronary bypass surgery (p < 0.001). Left ventricular dysfunction was associated with higher mortality (p < 0.0001) and coronary bypass surgery (p = 0.045), but not Q-wave myocardial infarction (p = 0.99). Mortality was higher in elderly patients (p < 0.0001), but the incidence of Q-wave myocardial infarction was similar (p = 0.64). Older patients underwent coronary bypass surgery less often (p = 0.004). By multivariate analysis, only the extent of coronary disease (relative risk [RR] 1.71, confidence interval [CI] 1.34 to 2.19; p = 0.0001), diabetes mellitus (RR 1.82, CI 1.28 to 2.59; p = 0.001), hypertension (RR 1.30, CI 1.08 to 1.96, p = 0.009), male gender (RR 1.30, CI 0.99 to 1.71, p = 0.058), and prior myocardial infarction (RR 1.44, CI 1.14 to 1.81, p = 0.002) independently influenced the incidence of major adverse events. We conclude that it is possible to identify patients with worse long-term prognosis after percutaneous transluminal coronary angioplasty based on clinical and angiographic parameters.

Aged↗

PubMed1997

The changing face of coronary interventional practice. The Mayo Clinic experience.

BACKGROUND: Devices designed to facilitate or replace conventional percutaneous transluminal coronary angioplasty have been introduced in recent years. OBJECTIVES: To characterize the changes in percutaneous coronary interventional practice over 16 years and to assess the relative use of these new devices. METHODS: We performed a retrospective analysis of all patients who underwent percutaneous coronary revascularization at Mayo Clinic, Rochester, Minn, during a 16-year period (1980-1995) and characterized the changes in procedural and clinical factors. RESULTS: The number of coronary interventional procedures performed increased from 38 in 1980 to 1284 in 1995. Atherectomy and laser angioplasty were incorporated in 1988; their use peaked in 1994 (17% of procedures) but decreased to 9.9% by 1995. In contrast, the use of intracoronary stents has increased steadily since 1990. By 1995, intracoronary stents were placed in 48.2% of procedures. The success rate improved from 55.3% in 1980 to 91.4% in 1995, although patients were older (51 +/- 10 [mean +/- SD] years in 1980 vs 63 +/- 12 years in 1995), had more extensive coronary artery disease (0% with multivessel disease in 1980 vs 47.4% in 1995), had more complex lesions, and often underwent intervention in the peri-infarction setting (2.6% of procedures in 1980 vs 17% in 1995). The rate of referral to emergency coronary bypass surgery after percutaneous procedures declined from 5.2% in 1980 to 0.4% in 1995. CONCLUSIONS: Current coronary interventional practice is expanding and improving. In contrast to intracoronary stents that have greatly affected current practice, other new devices are used infrequently. Conventional angioplasty, with or without intracoronary stents, remains the dominant treatment strategy.

Adult↗

PubMed1997

Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization.

BACKGROUND: Cigarette smoking is known to be deleterious to patients with coronary artery disease, but the effect of smoking on the clinical outcome of percutaneous coronary revascularization is unknown. METHODS: Patients who had undergone successful percutaneous coronary revascularization at the Mayo Clinic between 1979 and 1995 were divided into nonsmokers (n=2009), former smokers (those who had stopped smoking before the procedure, n=2259), quitters (those who stopped smoking after the procedure, n=435), and persistent smokers (those who smoked before and after the procedure, n=734). RESULTS: The maximal follow-up was 16 years (mean [+/-SD], 4.5+/-3.4). The nonsmokers and former smokers had similar base-line characteristics and outcomes. The quitters and persistent smokers were younger than the nonsmokers and former smokers and had more favorable clinical and angiographic characteristics. In analyses adjusted for confounding base-line characteristics, the persistent smokers had a greater relative risk of death (1.76 [95 percent confidence interval, 1.37 to 2.26]) and of Q-wave infarction (2.08 [95 percent confidence interval, 1.16 to 3.72]) than the nonsmokers. The quitters and persistent smokers were less likely than the nonsmokers to undergo additional percutaneous coronary procedures (relative risk, 0.80 [95 percent confidence interval, 0.64 to 0.98] and 0.67 [95 percent confidence interval, 0.56 to 0.81], respectively) or coronary bypass surgery (relative risk, 0.72 [95 percent confidence interval, 0.54 to 0.95] and 0.68 [95 percent confidence interval, 0.54 to 0.86], respectively). The persistent smokers were also at greater risk for death than the quitters (relative risk, 1.44 [95 percent confidence interval, 1.02 to 2.11]). CONCLUSIONS: Patients who continued to smoke after successful percutaneous coronary revascularization were at greater risk for Q-wave infarction and death than nonsmokers. The cessation of smoking either before or after percutaneous revascularization was beneficial. Patients undergoing percutaneous revascularization should be encouraged to stop smoking.

Aged↗

PubMed1997

Mechanical pressure and stretch release endothelin-1 from human atherosclerotic coronary arteries in vivo.

BACKGROUND: Endothelin-1 (ET-1) is an endothelium-derived vasoactive peptide with mitogenic properties. In vitro, vascular release of ET-1 is increased in response to mechanical stress. The goal of the present study was to examine whether ET-1 is released from human atherosclerotic coronary arteries in vivo in response to mechanical pressure and stretch and to characterize immunoreactivity for ET-1 and its precursor, big ET-1, within the atheromatous plaque. METHODS AND RESULTS: Circulating ET-1 levels were measured in 20 patients before and after coronary angioplasty for stable angina at three sampling sites: the femoral artery and the coronary artery segments proximal and distal to the lesion dilated. In addition, atheromatous tissue obtained from 20 patients undergoing directional coronary atherectomy for stable angina were analyzed for immunoreactivity for ET-1 and big ET-1. In patients undergoing angioplasty, ET-1 levels in the distal coronary artery increased after balloon dilatation (8.4 +/- 0.9 to 16.4 +/- 2 pg/mL, P < .05); proximal coronary artery and systemic ET-1 levels were unchanged. The degree of mechanical stress applied (product of duration and pressure of balloon inflation) correlated with the change in distal coronary artery ET-1 levels (r = .71, P < .01). Immunoreactivity for big ET-1 and ET-1 was ubiquitous in the extracellular space and the intracellular compartment (macrophages, myointimal cells, myofibroblasts, and endothelial cells) of human coronary atheromatous tissue. CONCLUSIONS: Big ET-1 and ET-1 immunoreactivity is ubiquitous within the intracellular and extracellular compartments of coronary atherosclerotic tissue. ET-1 is released from these sites in response to mechanical stress. These findings support a role for endothelins in the evolution and progression of coronary atherosclerosis in humans.

Aged↗

PubMed1997

Interventional cardiology and intracoronary stents--a changing practice: approved vs. nonapproved indications.

Our objective was to document change in stent usage in a single practice over time and to study "off-label" compared to Food and Drug Administration (FDA)-approved indications. Although only two intracoronary stents have been approved by the FDA, the relatively limited approved indications do not account for the dramatic increase in stent implantation. This increase has important implications for patient health care delivery. This study of stent usage in a single center over a 36-mo period included all patients treated with coronary stents at the Mayo Clinic from January 1993-December 1995, and evaluated the relative difference in frequency between "off-label" and FDA-approved indications for implantation. During the 36-mo period of study, 3,614 interventional procedures were done and one or more stents were placed in 25.4% of patients. The proportion of patients receiving stents increased throughout this time: during the first 6-mo period, stents were placed in 6.2% of procedures; during the last 6-mo period, stents were placed in 46.3% of procedures, an eightfold increase. During the final 6 mo, an unapproved device or an unapproved indication for an approved device constituted 59.4% of all stent procedures. In addition, use of the non-FDA-approved adjunctive treatment regimen without warfarin increased from 2.9% in the first 6-mo period of observation to 82.7% in the last 6 mo. The use of stents increased strikingly over a 36-mo period, from 6% to 46% of all procedures. The majority of implantations were performed either for an "off-label" unapproved indication or with an unapproved device.

Angioplasty, Balloon, Coronary↗

PubMed1997

Histologic correlates of angiographic chronic total coronary artery occlusions: influence of occlusion duration on neovascular channel patterns and intimal plaque composition.

OBJECTIVES: Age-related changes in histologic composition and neovascular channel (NC) pattern of angiographic chronic total coronary artery occlusions (CTOs) were studied to define histologic correlates of age-related revascularization profiles and neovascular channel formation. BACKGROUND: Revascularization of CTOs is frequently characterized by inability to cross or dilate the lesion and a high incidence of reocclusion or restenosis but low periprocedural ischemic complication rates. Little is known about the histopathologic basis of these observations. METHODS: Ninety-six angiographic CTOs from autopsy studies in 61 patients who had undergone coronary angiography within 3 months of death were studied. Abrupt plaque rupture was excluded. Occlusion segments were analyzed for 1) histologic composition as a function of lesion age; and 2) NC pattern as a function of lesion age and intimal plaque (IP) composition. RESULTS: Cholesterol and foam cell-laden IP was more frequent in younger lesions (p = 0.0007), whereas fibrocalcific IP increased with CTO age (p = 0.008). IP NCs arose directly from adventitial vasa vasorum and were anatomically and quantitatively related in terms of number and size (p = 0.0001) to the extent of IP cellular inflammation. IP cellular inflammation exceeded that found in the adventitia (p < 0.001) or media (p = 0.0001) across all CTO ages. In CTOs < 1 year old, the adventitia was associated with a larger number and size of NCs relative to the IP (p = 0.0006 and p = 0.009), media (p = 0.0001 and p = 0.002) and recanalized lumen (p = 0.0001 and p = 0.001). In CTOs >1 year old, the adventitia and IP NC numbers were similar and exceeded NC numbers found in the media (p = 0.0001) and recanalized lumen (p = 0.0001 and p = 0.003). CONCLUSIONS: Angiographic CTO frequently corresponds to less than complete occlusion by histologic criteria. Age-related changes in IP composition from cholesterol laden to fibrocalcific may explain the adverse revascularization profile of older CTOs. IP NC growth derived from the adventitia increases with age and is strongly associated with IP cellular inflammation. IP NC formation may protect against the flow-limiting effects of IP growth.

Adult↗

PubMed1997

Clinical outcome of patients undergoing endoluminal coronary artery reconstruction with three or more stents.

OBJECTIVES: We sought to evaluate the outcome of patients undergoing multiple (three or more), contiguous stent implantation within a single native coronary artery. BACKGROUND: The implantation of multiple stents within a single coronary artery is increasing in frequency, although the outcome of such patients is not well described. METHODS: Forty-five patients without previous coronary artery bypass graft surgery (CABG) undergoing multiple, contiguous stent implantation in a single coronary artery were identified. Clinical and angiographic characteristics and outcomes were analyzed. RESULTS: The angiographic success rate was 97.8%. The procedural success rate was 91.1%; stent occlusion during the initial hospital period occurred in four patients (8.9%). Death, myocardial infarction (MI), CABG, repeat target vessel intervention or severe angina occurred in 10 (23.3%) of 43 hospital survivors at 6-months follow-up. The indication for stent placement was threatened or abrupt closure in 30 patients (66.7%). Of the 25 patients with abrupt or threatened closure whose clinical and angiographic data would have indicated emergent CABG had stents not been available, the frequency of in-hospital death and Q wave MI was similar to that of a matched consecutive series of patients at our institution who underwent emergent CABG after failed angioplasty. At 1 year, the frequency of death, Q wave MI, CABG and severe angina at 1 year was similar in the two groups; the need for repeat percutaneous intervention was more common in the stent group (25% vs. 0%, p = 0.01). CONCLUSIONS: Implantation of multiple, contiguous intracoronary stents was associated with a high initial success rate, although the incidence of early stent closure was relatively high. Adverse events at 6 months of follow-up were more frequent than previously reported for elective single-stent implantation; however, adverse angiographic characteristics such as dissection and thrombus were frequent in this group. In addition, the strategy of multiple stent implantation in the setting of failed angioplasty is a reasonable alternative to emergent CABG, although the need for further percutaneous intervention must be anticipated.

Angioplasty, Balloon, Coronary↗

PubMed1997

Effect of infarct-related artery patency and late potentials on late mortality after acute myocardial infarction.

OBJECTIVE: To assess the effect of patency of the infarct-related artery and the presence of late potentials on late cardiac mortality after myocardial infarction. MATERIAL AND METHODS: We studied the influence of the infarct-related artery patency and the presence of late potentials during signal-averaged electrocardiography on late mortality in 124 survivors of acute myocardial infarction. In addition, we assessed predictive factors of cardiac mortality by univariate and multivariate statistical analysis. RESULTS: A study group of 98 men and 26 women (mean age, 59 years) who were survivors of acute myocardial infarction underwent follow-up for a mean of 3.6 +/- 1.0 years. Immediate reperfusion therapy (thrombolysis or direct angioplasty) was accomplished in 71 patients (57%). During follow-up, 13 cardiac-associated deaths occurred. Infarct-related artery patency was strongly associated with improved survival, but the presence of late potentials did not correlate with increased mortality, even among patients with impaired left ventricular function. Univariate and multivariate analyses identified occluded infarct-related arteries, prior myocardial infarction, reduced left ventricular ejection fraction, and advanced age, but not late potentials, as predictors of increased late cardiac mortality. CONCLUSION: These data suggest that coronary angiography may, but signal-averaged electrocardiography may not, identify patients with increased late risk of cardiac-related death after myocardial infarction. The low mortality among patients who have undergone successful reperfusion therapy may reduce the ability of noninvasive tests to distinguish between high- and low-risk patients.

Analysis of Variance↗