Short-term and long-term prognosis after myocardial infarction: prognostic value of coronary anatomy and left ventriculography

Abstract

To assess prospectively short-term (1 year) and long-term (4 years) prognostic variables from heart catheterization, 325 consecutive patients of 65 years or less who survived a myocardial infarction were studied. In all coronary angiography and left ventriculography was performed 4-6 weeks after infarction. First year mortality rate was significantly higher in patients with an ejection fraction less than 0.30 (20%) than in patients with an ejection fraction greater than or equal to 0.30 (2%, P less than 0.001). During 4-year follow-up cumulative mortality was 44% in patients with an ejection fraction less than 0.30 vs 11% in patients with an ejection fraction greater than or equal to 0.30 (P less than 0.001). In patients who survived the first year after infarction, however, a low ejection fraction less than 0.30 was not associated with higher mortality rate during the subsequent 3 years. Mortality in patients with one-, two- or three-vessel disease was equally distributed in the first year. After 4 years patients with three-vessel disease had a significant higher mortality (32%) than patients with two- or one-vessel disease (12 and 11%, respectively; P less than 0.05). Reinfarction rate was higher in patients with an ejection fraction less than 0.30 (14%) than in patients with an ejection fraction greater than or equal to 0.30 (3%, P less than 0.05) in the first year. During 4-year follow-up reinfarction rate was 38% in patients with an ejection fraction less than 0.30 vs. 13% in patients with an ejection fraction greater than or equal to 0.30 (P less than 0.05). Again, in patients who survived the first year without reinfarction, an ejection fraction less than 0.30 had no prognostic value for recurrent myocardial infarction during the subsequent three years. Three-vessel disease had no higher reinfarction rate in the first year of follow-up: during 4 years, patients with three-vessel disease had a reinfarction rate (32%) compared to patients with two- and one-vessel disease (14 and 11%, respectively; P less than 0.05). It is concluded that an ejection fraction less than 0.30 is a major risk factor for cardiac death and reinfarction only in the first year after myocardial infarction. Beyond the first year, a subgroup of patients with three-vessel disease is at risk for both cardiac death and reinfarction during the three subsequent years.