Author + information
- Received September 4, 1984
- Revision received October 30, 1984
- Accepted November 15, 1984
- Published online April 1, 1985.
- Heiner Blanke, MD1,
- Marc Cohen, MD, FACC1,
- Karl R. Karsch, MD1,
- Richard Fagerstrom, PhD and
- K. Peter Rentrop, MD, FACC*,1
- ↵*Address for reprints: K. Peter Rentrop, MD, Division of Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, New York 10029.
Residual flow to the infarct zone was assessed by coronary angiography during the acute phase of myocardial infarction in 130 patients. In 36 patients, the infarct-related coronary artery was not completely obstructed, thereby providing residual anterograde flow to the infarct area (Group I). Complete obstruction of the infarct vessel with residual flow to the infarct zone by means of collateral circulation was observed in 56 patients (Group II). Complete obstruction of the infarct vessel without residual flow was seen in 38 patients (Group III). Ejection fraction during the acute phase of infarction was found to be significantly higher in Group I (55 ± 13%) than in either Group II (48 ± 13%) or Group III (50 ± 10%) (p < 0.05). Group II patients had a longer history of angina pectoris (14.2 ± 21.4 months) than did Group III patients (0.7 ± 3.1 months) (p < 0.01). Patients in Group I and Group II were more likely to be taking antianginal medication (56 and 54%, respectively) than were the patients in Group III (16%) (p < 0.01).
Thirty-seven patients in whom reperfusion techniques were not employed had repeat angiography in the chronic phase of infarction, enabling assessment of spontaneous changes in left ventricular function and coronary morphology. Ejection fraction (EF) did not change significantly from the acute to the chronic stage in Group I (ΔEF = −1.3 ± 11.4%; n = 12) or Group II (AEF = −1.4 ± 7.9%; n = 16); however, there was a significant decrease in Group III (AEF = −10.1 ± 7.5%; n = 9; p < 0.01). Two findings characterized the patients with initial complete coronary obstruction whose ejection fraction did not decrease: collateral flow to the infarct area at angiography during the acute phase of infarction in conjunction with spontaneous recanaliza-tion demonstrated at later repeat angiography. It is concluded that the prevalence of residual flow may be an important covariate in assessing the efficacy of interventions designed to limit infarct size.
- Received September 4, 1984.
- Revision received October 30, 1984.
- Accepted November 15, 1984.
- American College of Cardiology Foundation