(Circulation. 1996;93:1114-1122.)
© 1996 American Heart Association, Inc.
Articles |
Patency of Infarct-Related Artery
Effect of Restoration of Anterograde Flow on Vagal Reflexes
From the Divisione di Cardiologia, Centro Medico di Montescano, Fondazione Clinica del Lavoro, IRCCS (A.M., M.T.L.R.) and the Cattedra di Cardiologia, Dipartimento di Medicina Interna, University of Pavia (Italy), Policlinico S. Matteo, IRCCS (G.S., P.J.S.); the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (J.T.B.Jr); the Department of Medicine, University Medical Center, University of Arizona, Tucson (F.I.M.); the Department of Cardiological Sciences, St George Hospital, Medical School, London, UK (J.A.C.); the Department of Cardiology, University Hospital Freiburg (Germany) (S.H.H.); the Third Division of Internal Medicine, Kyoto (Japan) University Hospital, Sakyoku (R.N.); and the Centro di Fisiologia Clinica ed Ipertensione, Istituto di Clinica Medica Generale e Terapia Medica, University of Milan (Italy) (P.J.S.).
Correspondence to Andrea Mortara, MD, Divisione di Cardiologia, Centro Medico di Montescano, 27040 Montescano (Pavia), Italy.
Background In post–myocardial infarction (MI) patients, the restoration of anterograde flow in the infarct-related artery (IRA) significantly improves survival. Limitation of infarct size and increased electrical stability of the myocardium are likely operating mechanisms for this beneficial effect. We tested the hypothesis that patency of the IRA may enhance vagal reflexes, a factor known to affect electrical stability of the infarcted myocardium.
Methods and Results Analysis of angiographic data was performed in 359 of 1284 post-MI patients enrolled in a multicenter prospective study within 8 weeks after the index MI. All the patients underwent baroreflex sensitivity (BRS) assessment by the phenylephrine method. The BRS of the entire population averaged 8.2±5.5 ms/mm Hg and was significantly related to age but not to ejection fraction (EF). One-, two-, and three-vessel disease was present in 138, 96, and 99 patients, respectively, while no coronary stenosis was observed in 26. IRA patency was documented in 234 patients (65%), while in the remaining 125 (35%), the artery remained occluded. Patients with occluded IRAs had more extensive coronary disease (2 to 3 vessels, 71% versus 46%, P<.01) and more depressed left ventricular (LV) function (LVEF, 48±13% versus 53±12%, P<.001). Patency of the IRA was associated with higher BRS values (BRS, 8.9±5.8 versus 7.1±4.7 ms/mm Hg, P<.005) and with a lower incidence (9% versus 18%, P<.02) of markedly depressed BRS (<3 ms/mm Hg), a condition suggested by preliminary studies to be associated with an increased risk of post-MI mortality. The association between IRA patency and BRS was more evident in anterior than in inferior MI. Multivariate regression analysis showed that age of the patient and patency of the IRA were the major independent determinants of BRS, while LVEF was weakly related to BRS and only when analyzed as a categorized variable.
Conclusions The presence of an open IRA is associated with a higher baroreflex sensitivity, and this effect is largely independent of limitation of infarct size by IRA patency. These data offer new insights into the mechanisms by which coronary artery patency may affect cardiac electrical stability and survival.
Key Words: myocardial infarction • reperfusion • angiography • nervous system, autonomic
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