| Influence of late reopening of the infarct-related artery on left ventricular remodelling after myocardial infarction. IRIS Study Group. | |
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MedLine Citation:
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PMID: 9458418 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: This trial was undertaken to assess the impact of late reopening of the infarct-related artery on left ventricular remodelling in post-myocardial infarction patients. METHODS: One hundred and fifty seven patients with recent myocardial infarction were routinely submitted to delayed (second week) catheterization. They also underwent systematic angioplasty of a significantly narrowed infarct-related artery with a suitable anatomy, or reopening of a totally occluded infarct-related artery, and repeat follow-up catheterization after 4 months. Changes in left ventricular ejection fraction, left ventricular volumes, and percent of regional hypokinesia were assessed over the study period. RESULTS: One hundred and thirty-two patients had two interpretable left ventriculograms and two interpretable coronary angiograms. At initial angiography, 56 out of 96 patients with a patent infarct-related artery were successfully submitted to percutaneous coronary angioplasty, of whom 25 had restenosis and eight had total reocclusion at follow-up angiography. Percutaneous transluminal coronary angioplasty was not attempted in the remaining 40 patients due to unsuitable anatomy in 18 or a nonsignificant lesion in 22. The infarct-related artery was totally occluded in 36 patients at initial angiography, and successfully reopened by means of angioplasty in 19, of whom seven showed a reocclusion at follow-up angiography. The independent predictors of left ventricular enlargement, identified by means of multivariate regression analysis, were initial stroke volume index < 40 ml.m-2 (odds ratio = 6.3, 95% confidence interval = [2.5; 16.6]), initial end-systolic volume index > 50 ml.m-2 (odds ratio = 7.1, 95% confidence interval = [1.5; 25.8]), anterior infarct location (odds ratio = 4.1, 95% confidence interval = [1.4; 11.5]) and reocclusion of the infarct-related artery (odds ratio = 7.3, 95% confidence interval = [1.3; 27.3]). Angioplasty of a patent but significantly narrowed infarct-related artery was not found predictive. CONCLUSIONS: This study demonstrates that reocclusion of a previously open infarct-related artery, as well as the initial low stroke volume index, enlarged end-systolic volume index and anterior infarct location are independent predictors of long-term left ventricular enlargement. These results emphasize the impact of long-term sustained patency of the infarct-related artery on the prevention of left ventricular dysfunction. The need for a larger randomized trial is recognised. |
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Authors:
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N Meneveau; J P Bassand; C Bauters; J Y Rozand; J L Petit; D Beurrier; G Grollier; F Andre; A Vahanian; J F Viel |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European heart journal Volume: 18 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 1997 Aug |
Date Detail:
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Created Date: 1998-03-18 Completed Date: 1998-03-18 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 1261-8 Citation Subset: IM |
Affiliation:
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Hôpital Universitaire Saint-Jacques, Besançon, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Aged Angioplasty, Transluminal, Percutaneous Coronary* Chi-Square Distribution Coronary Angiography Female Humans Logistic Models Male Middle Aged Multivariate Analysis Myocardial Infarction / drug therapy, physiopathology, therapy* Thrombolytic Therapy Time Factors Treatment Outcome Vascular Patency* Ventricular Function, Left* |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 1997 Aug;18(8):1207-9
[PMID:
9458412
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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