Long-term Implications of Reocclusion on Left Ventricular Size and Function After Successful Thrombolysis for First Anterior Myocardial Infarction

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Abstract
Background Successful thrombolysis can prevent left ventricular dilatation after acute myocardial infarction. However, in almost 30% of patients, reocclusion occurs. The aim of this study was to assess the long-term implications of reocclusion on left ventricular size and function. Methods and Results Fifty-six patients were studied with two-dimensional echocardiography at baseline (2±1.6 days) and 5.0±1.4 years after first anterior myocardial infarction. All patients (a subset of those enrolled in the APRICOT trial) had a patent infarct-related artery when studied P =.008) and end-systolic volume index (ESVI; P =.039). Furthermore, patients without reocclusion demonstrated improvement in wall motion score index (WMSI; P =.0001) and ejection fraction (EF; P =.016), whereas patients with reocclusion did not. After 5 years, patients with reocclusion had significantly larger volume indexes (EDVI, 99±41 versus 76±22 mL/m 2 , P =.007; ESVI, 59±40 versus 39±20 mL/m 2 , P =.017) and more compromised left ventricular function (WMSI, 1.63±0.33 versus 1.39±0.32, P =.013; EF, 45±13% versus 51±11%, P =.077) than patients without reocclusion. Multivariate analysis identified baseline WMSI and reocclusion as significant independent predictors of left ventricular dilatation. Conclusions Reocclusion of the infarct-related artery within 3 months of successful thrombolysis is associated with left ventricular dilatation and is detrimental to functional recovery of left ventricular function 5 years after first anterior myocardial infarction.

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