Clinical, Hemodynamic and Angiographic Findings in 94 Patients with Old Myocardial Infarction

Comparison with 79 Patients with Coronary Artery Disease and No Myocardial Infarction

Abstract

Clinical, hemodynamic, coronary arteriographic, and ventriculographic findings of 94 patients (pts) with coronary artery disease (CAD) and old myocardial infarction (MI) have been described and compared with those of 79pts with CAD and no previous MI.
Pts with old MI presented a more compromised functional and hemodynamic status, with a higher incidence of NYHA class III-IV pts (40%), symptoms of left ventricular (LV) failure (31%), cardiomegaly (70%), higher left ventricular end-diastolic pressure (LVEDP) (19.6±9.6mmHg; p<0.05), compared with 32%, 22%, 54% and 16.0±6.8mmHg respectively in CAD pts with no MI.
MI pts presented more severe CAD, higher incidences of three vessel disease (56%, p<.005) and of left anterior descending (LAD) (34%) and right coronary artery (RCA) (36%) occlusions, compared with 34%, 6%, and 9% respectively in pts with no MI.
Furthermore, pts with old MI showed more diffuse and severe LV segmental wall contraction abnormalities, with higher frequencies of LV aneurysm (31%) and of pts with asynergy of more than 2LV segments (26%), compared with 1% and 3% respectively in pts with no MI.
Within the group with old MI, LVEDP was higher in pts with anterior (A) (22.0±11mmHg, p<.02)and anterior+diaphragmatic (A+D) (21.5±7.9mmHg, p<.05) MI, compared with pts with diaphragmatic (D) MI (16.6±7.1mmHg); furthermore, LVEDP increase was significantly correlated with the severity and the extent of LV asynergy.
In A and D MI, LAD and RCA stenoses or occlusions were prevalent respectively; pts with A+D MI showed larger numbers of coronary stenosis (3.05) and occlusion (1.05) per patient. The coronary artery supplying the infarcted area showed stenosis (≥75%) in 95.6% and was normal in 2.2% of cases.
Thus, pts with CAD and old MI, and particularly of A+D and A MI, show a more compromised hemodynamic status and more severe degrees of CAD and of LV segmental wall contraction abnormality, which are responsible for their poor prognosis, compared to pts with CAD but no old MI.