PATENCY OF THE INFARCT-RELATED ARTERY AND LEFT-VENTRICULAR FUNCTION AS THE MAJOR DETERMINANTS OF SURVIVAL AFTER Q-WAVE ACUTE MYOCARDIAL-INFARCTION

One hundred seventy-two patients with 1-vessel disease documented at predischarge angiography who had been followed for 43 +/- 30 months after an initial Q-wave acute myocardial infarction were retrospectively evaluated to investigate the prognostic value of infarct-related artery patency and left ventricular (LV) function. Multiple logistic regression analysis revealed that only infarct artery patency (Thrombolysis in Myocardial infarction [TIMI] grades 2-3 vs 0-1) (Z = 2.24; p <0.05) and end-systolic volume index (Z = -2.67; p <0.01) were independently related to survival. Sixteen cardiac deaths were observed; all 16 patients had LV dysfunction (defined as end-systolic volume index >40 ml/m2), and 15 had an occluded infarct-related artery, In the subgroup with LV dysfunction, the 10-year percent survival rate was 20% among patients with TIMI grade 0 to 1 versus 96% with grade 2-3 (p <0.001). Patency of the infarct-related artery was also the only independent predictor of recurrent ischemia (Z = 2.59; p <0.01). In conclusion, both infarct-related artery patency and LV function are independent predictors of survival after Q-wave acute myocardial infarction. Patients with normal LV function have an excellent long-term prognosis, which is only partially counterbalanced by the tendency toward clinical instability observed in those with an open infarct-related vessel. However, when an occluded infarct-related artery is observed in the setting of LV dysfunction, the long-term outcome appears to be relatively poor.