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. 1987 Oct;58(4):345–351. doi: 10.1136/hrt.58.4.345

The effects of early coronary patency on the evolution of myocardial infarction: a prospective arteriographic study.

A D Timmis 1, B Griffin 1, J C Crick 1, D J Nelson 1, E Sowton 1
PMCID: PMC1277266  PMID: 3314951

Abstract

The effects of early spontaneous coronary patency on the evolution of myocardial infarction were evaluated in 41 patients. They had coronary arteriography (mean (SEM)) 3.1 (0.2) hours after the onset of chest pain with repeat studies 90 minutes and three days later. In 12 (29%) patients the infarct related coronary artery was patent at the first arteriogram (group 1). A further 10 patients, nine of whom received thrombolytic treatment, showed early recanalisation of the infarct related coronary artery within 90 minutes of treatment (group 2). In the remainder the infarct related coronary artery was persistently occluded (group 3). Baseline values for infarct location, the sum of ST elevation in all leads, QRS scores, and serum creatine kinase activity did not permit discrimination between the groups. Nevertheless, patterns of ST segment change and enzyme release in group 1 were closely similar to those that occurred in response to thrombolysis in group 2. Thus compared with group 3, groups 1 and 2 showed earlier 50% reduction in the sum of peak ST elevation in all leads and earlier peaking of serum creatine kinase activity. Importantly, creatine kinase release was significantly attenuated in group 1, rising to a peak serum activity (mean (SEM)) of only 1242 (415) IU/1. Analysis of angiographic left ventricular ejection fractions at three days indicated limitation of infarct size in groups 1 and 2 compared with group 3. Mean (SEM) ejection fraction, however, was best preserved in group 1 (62(6)%) and in this group the frequency of non-Q wave infarction was higher than in groups 2 and 3. Thus in patients who present with a patent infarct related coronary artery early during infarction: (a) there is a reduction in the pattern of infarct size as reflected by attenuation of release of creatine kinase, preservation of left ventricular ejection fraction, and a relatively high frequency of non-Q wave infarction; (b) patterns of ST segment change and creatine kinase release resemble those that occur after successful thrombolytic treatment, suggesting that early coronary patency is the result of spontaneous recanalisation of a previously occluded artery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baughman K. L., Maroko P. R., Vatner S. F. Effects of coronary artery reperfusion on myocardial infarct size and survival in conscious dogs. Circulation. 1981 Feb;63(2):317–323. doi: 10.1161/01.cir.63.2.317. [DOI] [PubMed] [Google Scholar]
  2. DePace N. L., Iskandrian A. S., Hakki A. H., Kane S. A., Segal B. L. Use of QRS scoring and thallium-201 scintigraphy to assess left ventricular function after myocardial infarction. Am J Cardiol. 1982 Dec;50(6):1262–1268. doi: 10.1016/0002-9149(82)90460-x. [DOI] [PubMed] [Google Scholar]
  3. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  4. DeWood M. A., Stifter W. F., Simpson C. S., Spores J., Eugster G. S., Judge T. P., Hinnen M. L. Coronary arteriographic findings soon after non-Q-wave myocardial infarction. N Engl J Med. 1986 Aug 14;315(7):417–423. doi: 10.1056/NEJM198608143150703. [DOI] [PubMed] [Google Scholar]
  5. Fioretti P., Brower R. W., Lazzeroni E., Simoons M. L., Wijns W., Reiber J. H., Bos R. J., Hugenholtz P. G. Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction. Br Heart J. 1985 Mar;53(3):248–252. doi: 10.1136/hrt.53.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gibson R. S., Beller G. A., Gheorghiade M., Nygaard T. W., Watson D. D., Huey B. L., Sayre S. L., Kaiser D. L. The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q wave infarction: a prospective natural history study. Circulation. 1986 Jun;73(6):1186–1198. doi: 10.1161/01.cir.73.6.1186. [DOI] [PubMed] [Google Scholar]
  7. Ginks W. R., Sybers H. D., Maroko P. R., Covell J. W., Sobel B. E., Ross J., Jr Coronary artery reperfusion. II. Reduction of myocardial infarct size at 1 week after the coronary occlusion. J Clin Invest. 1972 Oct;51(10):2717–2723. doi: 10.1172/JCI107091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hackworthy R. A., Vogel M. B., Harris P. J. Influence of infarct artery patency on the relation between initial ST segment elevation and final infarct size. Br Heart J. 1986 Sep;56(3):222–225. doi: 10.1136/hrt.56.3.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hackworthy R. A., Vogel M. B., Harris P. J. Relationship between changes in ST segment elevation and patency of the infarct-related coronary artery in acute myocardial infarction. Am Heart J. 1986 Aug;112(2):279–284. doi: 10.1016/0002-8703(86)90262-0. [DOI] [PubMed] [Google Scholar]
  10. Huey B. L., Gheorghiade M., Crampton R. S., Beller G. A., Kaiser D. L., Watson D. D., Nygaard T. W., Craddock G. B., Sayre S. L., Gibson R. S. Acute non-Q wave myocardial infarction associated with early ST segment elevation: evidence for spontaneous coronary reperfusion and implications for thrombolytic trials. J Am Coll Cardiol. 1987 Jan;9(1):18–25. doi: 10.1016/s0735-1097(87)80076-1. [DOI] [PubMed] [Google Scholar]
  11. Kennedy J. W., Ritchie J. L., Davis K. B., Fritz J. K. Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. N Engl J Med. 1983 Dec 15;309(24):1477–1482. doi: 10.1056/NEJM198312153092402. [DOI] [PubMed] [Google Scholar]
  12. Nicod P., Corbett J. R., Sanford C. F., Mukharji J., Dehmer G. J., Croft C. H., Rude R. E., Lewis S., Willerson J. T. Comparison of the influence of acute transmural and nontransmural myocardial infarction on ventricular function. Am Heart J. 1984 Jan;107(1):28–34. doi: 10.1016/0002-8703(84)90129-7. [DOI] [PubMed] [Google Scholar]
  13. Norris R. M., Caughey D. E., Deeming L. W., Mercer C. J., Scott P. J. Coronary prognostic index for predicting survival after recovery from acute myocardial infarction. Lancet. 1970 Sep 5;2(7671):485–487. doi: 10.1016/s0140-6736(70)90110-8. [DOI] [PubMed] [Google Scholar]
  14. Ong L., Reiser P., Coromilas J., Scherr L., Morrison J. Left ventricular function and rapid release of creatine kinase MB in acute myocardial infarction. Evidence for spontaneous reperfusion. N Engl J Med. 1983 Jul 7;309(1):1–6. doi: 10.1056/NEJM198307073090101. [DOI] [PubMed] [Google Scholar]
  15. Palmeri S. T., Harrison D. G., Cobb F. R., Morris K. G., Harrell F. E., Ideker R. E., Selvester R. H., Wagner G. S. A QRS scoring system for assessing left ventricular function after myocardial infarction. N Engl J Med. 1982 Jan 7;306(1):4–9. doi: 10.1056/NEJM198201073060102. [DOI] [PubMed] [Google Scholar]
  16. Reimer K. A., Jennings R. B. The "wavefront phenomenon" of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Lab Invest. 1979 Jun;40(6):633–644. [PubMed] [Google Scholar]
  17. Reimer K. A., Lowe J. E., Rasmussen M. M., Jennings R. B. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977 Nov;56(5):786–794. doi: 10.1161/01.cir.56.5.786. [DOI] [PubMed] [Google Scholar]
  18. Serruys P. W., Simoons M. L., Suryapranata H., Vermeer F., Wijns W., van den Brand M., Bär F., Zwaan C., Krauss X. H., Remme W. J. Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 1986 Apr;7(4):729–742. doi: 10.1016/s0735-1097(86)80330-8. [DOI] [PubMed] [Google Scholar]
  19. Shah P. K., Pichler M., Berman D. S., Singh B. N., Swan H. J. Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction. Relation to short-term prognosis. Am J Cardiol. 1980 Mar;45(3):542–546. doi: 10.1016/s0002-9149(80)80002-6. [DOI] [PubMed] [Google Scholar]
  20. Shell W. E., Kjekshus J. K., Sobel B. E. Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest. 1971 Dec;50(12):2614–2625. doi: 10.1172/JCI106762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Smalling R. W., Fuentes F., Matthews M. W., Freund G. C., Hicks C. H., Reduto L. A., Walker W. E., Sterling R. P., Gould K. L. Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction. Circulation. 1983 Jul;68(1):131–138. doi: 10.1161/01.cir.68.1.131. [DOI] [PubMed] [Google Scholar]
  22. Spodick D. H. Q-wave infarction versus S-T infarction. Nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions. Am J Cardiol. 1983 Mar 1;51(5):913–915. doi: 10.1016/s0002-9149(83)80160-x. [DOI] [PubMed] [Google Scholar]
  23. Timmis A. D., Griffin B., Crick J. C., Sowton E. Anisoylated plasminogen streptokinase activator complex in acute myocardial infarction: a placebo-controlled arteriographic coronary recanalization study. J Am Coll Cardiol. 1987 Jul;10(1):205–210. doi: 10.1016/s0735-1097(87)80181-x. [DOI] [PubMed] [Google Scholar]
  24. Young S. G., Abouantoun S., Savvides M., Madsen E. B., Froelicher V. Limitations of electrocardiographic scoring systems for estimation of left ventricular function. J Am Coll Cardiol. 1983 Jun;1(6):1479–1488. doi: 10.1016/s0735-1097(83)80052-7. [DOI] [PubMed] [Google Scholar]

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