Significance of location (anterior versus inferior) and type (Q-wave versus non-Q-wave) of acute myocardial infarction in patients undergoing percutaneous transluminal coronary angioplasty for postinfarction ischemia

doi:10.1016/S0002-9149(99)80125-8

The American Journal of Cardiology

Volume 76, Issue 7, 1 September 1995, Pages 431-435

https://doi.org/10.1016/S0002-9149(99)80125-8 Get rights and content

Abstract

Predictors of increased risk for recurrent cardiac events and death after acute myocardial infarction include postinfarction myocardial ischemia, anterior location of the infarct, and non-Q-wave versus Q-wave infarction. Although coronary angioplasty is performed in patients with postinfarction ischemia to alleviate symptoms, the outcome according to location and type of infarction and the effect on prevention of subsequent myocardial infarction and death are not known. To determine if location and type of myocardial infarction provide prognostic information in patients with postinfarction ischemia, we analyzed morbidity and mortality during and after coronary angioplasty according to the location (anterior vs inferior) and type (Q-wave vs non-Q-wave) of myocardial infarction in 505 consecutive patients. The incidence of recurrent angina, repeat coronary angioplasty, coronary bypass surgery, reinfarction, and death during long-term follow-up after hospital discharge (mean 34 ± 19 months) for the 440 patients with an initial successful angioplasty was also compared. During the procedure, there was no difference in the primary success rate or mortality among the different groups; however, more patients with anterior non-Q-wave myocardial infarction underwent emergent bypass grafting after unsuccessful coronary angioplasty (p = 0.001). Multivariate Cox proportional-hazards analyses controlling for age, gender, number of diseased vessels, location, type of infarction, and year of coronary angioplasty revealed that more patients with anterior infarction had ≥1 cardiac event (repeat angioplasty, coronary artery bypass grafting, reinfarction, or death) than did those with inferior infarction (RR 1.80, 95% confidence interval [CI] 1.22 to 2.65, p = 0.003). The rate of reinfarction or death was 1.93 times higher in patients with anterior than inferior infarction (95% CI 0.97 to 3.82, p = 0.057). There was no difference in these cardiac events for Q-wave versus non-Q-wave infarction (RR 1.15, 95% CI 0.78 to 1.69, p = 0.47). These results suggest that anterior location, but not type, of infarction was associated with a greater likelihood of a cardiac event at follow-up.

References (28)

HoltGW et al.
Results of percutaneous transluminal coronary angioplasty for angina pectoris early after acute myocardial infarction
Am J Cardiol
(1988)
SafianRD et al.
Usefulness of percutaneous transluminal coronary angioplasty for unstable angina pectoris after non-Q-wave myocardial infarction
Am J Cardiol
(1987)
HopkinsJ et al.
Recurrent ischemia in the zone of prior myocardial infarction: results of coronary angioplasty of the infarct-related artery
Am Heart J
(1988)
SuryapranataH et al.
Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction
Am J Cardiol
(1988)
AlfonsoF et al.
Percutaneous transluminal coronary angioplasty after non-Q-wave acute myocardial infarction
Am J Cardiol
(1990)
MorrisonDA
Coronary angioplasty for medically refractory unstable angina within 30 days of acute myocardial infarction
Am Heart J
(1990)
WeltyFK et al.
Similar results of percutaneous transluminal coronary angioplasty for women and men with post-myocardial infarction ischemia
J Am Coll Cardiol
(1994)
KannelWB et al.
Prognosis after initial myocardial infarction: The Framingham Study
Am J Cardiol
(1979)
StonePH et al.
Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location
J Am Coll Cardiol
(1988)
HutterAM et al.
Nontransmural myocardial infarction: a comparison of hospital and late clinical course of patients with that of matched patients with transmural anterior and transmural inferior myocardial infarction
Am J Cardiol
(1981)

KroneRJ et al.

Long-term prognosis after first Q-wave (“transmural”) or non-Q-wave (“non-transmural”) myocardial infarction: analysis of 593 patients

Am J Cardiol

(1983)

MarmorA et al.

Factors presaging early recurrent myocardial infarction (“extension”)

Am J Cardiol

(1981)

CollS et al.

Prevalence and prognosis after a first nontransmural myocardial infarction

Am J Cardiol

(1983)

HueyBL et al.

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)

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Significance of location (anterior versus inferior) and type (Q-wave versus non-Q-wave) of acute myocardial infarction in patients undergoing percutaneous transluminal coronary angioplasty for postinfarction ischemia

Abstract

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