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Circulation, Vol 79, 791-796, Copyright © 1989 by American Heart Association
T Hirai, M Fujita, H Nakajima, H Asanoi, K Yamanishi, A Ohno and S Sasayama
The effect of preexistent coronary collateral perfusion on the prevention
of left ventricular aneurysm formation was examined in 47 patients
undergoing an intracoronary thrombolysis within 6 hours after the onset of
a first acute anterior myocardial infarction. Left ventricular aneurysm
formation and wall motion were analyzed with cineventriculography. A left
ventricular aneurysm was determined as well-defined demarcation of the
infarcted segment from normally contracting myocardium. In 25 patients with
successful thrombolysis (group A), a left ventricular aneurysm was observed
in one patient (4%) during the chronic stage of infarction. In 10 patients
who had a significant collateral circulation to the infarct-related
coronary artery and unsuccessful reperfusion (group B), the left
ventricular aneurysm was observed in only one patient (10%). In the
remaining 12 patients with unsuccessful recanalization in the absence of a
significant collateral perfusion (group C), there was a higher incidence
(seven of 12, 58%) of left ventricular aneurysm formation than in groups A
and B (p less than 0.05). In group A, both the global ejection fraction and
regional wall motion in the infarct areas improved significantly (p less
than 0.05) between the acute and chronic stages of infarction. By contrast,
in groups B and C, these indexes on the ventricular function did not change
significantly during the convalescent period. Thus, although the collateral
perfusion existing at the onset of acute myocardial infarction may not
improve ventricular function, it exerts a beneficial effect on the
prevention of left ventricular aneurysm formation.
ARTICLES
Importance of collateral circulation for prevention of left ventricular aneurysm formation in acute myocardial infarction
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
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