Coronary arteriography in complicated acute myocardial infarction; clinical and angiographic correlates

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From January 1979 to June 30, 1979, we performed coronary arteriography in more than 350 patients with acute and subacute myocardial infarction.

The purpose of this paper is to study 301 patients with myocardial infarction complicated in the acute and subacute period by (1) angina, (2) acute mitral regurgitation, (3) perforation of the interventricular septum, (4) ventricular fibrillation, (5) intractable recurrent ventricular tachycardia-fibrillation, (6) heart failure, and (7) cardiogenic shock (Table 1).

The studies were performed within 6 hours to 30 days after acute and subacute myocardial infarction and a few hours after the onset of complications. The coronary arteriograms were performed by the Sones technique without the aid of mechanical circulatory assistance, and there were no deaths associated with the studies.

Acute and subacute myocardial infarction was diagnosed by the clinical history, electrocardiogram, and serum enzyme levels. We consider only severe obstructions (>70% narrowing).

Angina after acute and subacute myocardial infarction

Two hundred thirty-six patients had angina within 30 days of an acute and subacute myocardial infarction (Table 2). Usually the pain was severe, repetitive, and appeared at rest. We identify six different angiographic groups.1

Group I. Severe obstruction of a coronary artery (≥70%) without collateral circulation producing an area of infarction smaller than the zone perfused by that artery, with a surrounding area of ischemia. The left ventriculogram shows an area of akinesia or hypokinesia smaller than the total zone irrigated by that artery.

Group II. The same anatomy as that in group I, but in addition there . . .



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