Resolution of an obstructive coronary lesion as demonstrated by selective angiography in a patient with transmural myocardial infarction

Henderson, Robert R.; Hansing, Charles E.; Razavi, Mehdi; Rowe, George G.

doi:10.1016/0002-9149(73)90016-7

Cited by 47 publications

(4 citation statements)

References 18 publications

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“…Regression of coronary angiographic findings have repeatedly been reported in individual cases (21,29,31,71). In our study, 22 patients showed such a regression at the time of the second coronary angiography.…”

Section: Regression Ofangiographic Findingssupporting

confidence: 77%

Myocardial Infarction at a Young Age (Under 40 Years)

Roskamm¹,

Gohlke²,

Stürzenhofecker³

et al. 1984

Int J Sports Med

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Coronary morphology, risk factors, long-term prognosis, and progression of coronary arteriosclerosis were investigated in 679 (649 mean and 30 women) post-infarction patients under 40 years of age. These patients represented 80% of 844 MI patients under 40 who were referred to our hospital in the years 1973-1980; 20% had refused coronary angiography; 465 patients were followed up for 1-7 years (mean 3.5 years). In 164 patients, a second coronary angiography was performed 3.8 years after the first angiogram, which was done an average 3 months after the acute episode. The main results were as follows: 8.4% of the patients had zero-vessel disease and 3.7% had a normal coronary angiogram. The majority had single-vessel disease (57.3%). The prevalence of zero-vessel disease decreased with age while that of multivessel disease increased. With increasing vessel involvement, the prevalence of hypercholesterolemia, hypertriglyceridemia, and hypertension increased. A history of smoking was equally common in patients with zero-, single-, double-, and triple-vessel disease. In women the combination of smoking and the use of oral contraceptive drugs was frequently seen. In one-quarter of the zero-vessel disease patients, the infarction occurred during unusually intense physical exercise. The statistical analysis of the survival data using the proportional hazards model (univariate analysis) showed the variables heart volume/body wt., ventricular arrhythmias, PCP at rest, PCP max, work capacity, ventricular function, and number of diseased vessels to be of prognostic importance. Multivariate analysis using this model revealed the following independent variables to be relevant to prognosis: heart volume/body wt., ventricular arrhythmias, ventricular function, and number of diseased vessels. After an average of 3.8 years since the first coronary angiography, 28.6% of the patients showed a significant progression of coronary arteriosclerosis (at least two degrees of stenosis according to the AHA classification). In the subgroup of patients with multilocular disease in the first angiogram, progression was 10 times as frequent as in a group with initial unilocular disease (34.3% vs 3.6%). Patients with progression had continued to smoke significantly more often than patients without progression (38.4%) vs 14.5%). Regression of coronary angiographic findings was significantly more frequent in the group of patients with initial unilocular disease than in those with multilocular disease in the first angiogram (28.6% vs 10.6%). Regression might be explained as recanalization and organization of a thrombus.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Regression Ofangiographic Findingssupporting

confidence: 77%

Myocardial Infarction at a Young Age (Under 40 Years)

Roskamm¹,

Gohlke²,

Stürzenhofecker³

et al. 1984

Int J Sports Med

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“…In addition, microscopical changes of the arterial wall that might be related to thrombus formation have occurred after oestrogen medication (Irey et al, 1970). A review of communications on possible oestrogen-related myocardial infarction based on angiographic results (Dear and Jones, 1971;Glancy et al, 1971;Waxler et al, 1971;Kimbiris et al, 1972;Henderson et al, 1973;Maleki and Lange, 1973;Ciraulo, 1975) or necropsies (Hartveit, 1965;Naysmith, 1965;Osborn, 1965;Dalgard and Gregersen, 1969;Stout, 1969;Weiss, 1972) tends to corroborate this assumption because these reports document a higher than average incidence of coronary thrombosis and little evidence of generalised atherosclerosis. In contrast, diffuse and widespread atherosclerotic coronary disease is the common finding after myocardial infarction of atherosclerotic aetiology (Roberts and Buja, 1972).…”

Section: Discussionmentioning

confidence: 99%

Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

Engel¹,

Hundeshagen²,

Lichtlen³

1977

Heart

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A normal coronary arteriogram after transmural myocardial infarction is a well-recognised phenomenon, but the pathophysiology remains unclear in most cases. A possible aetiological role of oral contraceptives is suggested by the occurrence of unequivocal myocardial infarction with normal or near normal coronary arteries in 4 young women who had been taking oral contraceptives. While the cause-effect relation of coronary thrombosis and myocardial infarction remains controversial in patients with coronary atherosclerosis, a primary occlusion of macroscopically normal coronary arteries by cellular elements of blood appears possible in these cases. The action of contraceptives, the, would be analogous to their thrombogenic effect in peripheral veins and cerebral arteries. Absence of atherosclerotic lesions in these patients favours spontaneous thrombolysis and restoration of normal vessel patency in many of these cases. Myocardial blood flow in the region of the damaged left ventricular wall remains low in spite of normal coronary arteries. Reduced perfusion in infarcted areas is assumed to be the consequence of structural and functional alterations at precapillary and capillary level rather than an effect of obstructive coronary disease.

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“…In humans, coronary emboli, which occurred as a complication of coronary angiography, were seen to lyse spontaneously within 5 1 h-S weeks (44). Henderson et al observed progressive regression of an LAD lesion in a patient with anterior wall infarction, by performing serial coronary angiograms in the chronic stage of infarction (23). The changes of the coronary artery morphology from the acute to the chronic stage of infarction have not yet been analyzed by serial angiograms.…”

Section: Spontaneous Recanalization In Medically Treated Patients (Grmentioning

confidence: 99%

Initial experience with transluminal recanalization of the recently occluded infarct‐related coronary artery in acute myocardial infarction — Comparison with conventionally treated patients

Rentrop

Blanke

Karsch

et al. 1979

Clinical Cardiology

150

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In 7 patients, the recently occluded infarct‐related vessel was recanalized by transluminal catheter techniques during acute myocardial infarction (Group A). 4 patients had single‐vessel disease, 2 patients two‐vessels disease and one, involvement of three vessels. Control angiography was performed in 6 patients, 8 days to 7 months later. Changes of coronary artery anatomy and left ventricular function were compared with a group of 9 conventionally treated patients, who were found to have occlusion of the infarct‐related vessel in the acute stage (Group B). Five Group B patients had one‐vessel disease, 3 patients two‐vessel disease and 1 patient, involvement of all three vessels. In the chronic stage, all transluminally recanalized vessels were found to be patent in Group A. There was spontaneous recanalization of the infarct vessel in 4 of 9 Group B patients. In Group A, the length of the akinetic segment (AKS) decreased significantly (p < 0.05) from 145.4±48.5 mm to 73.2 ± 73.4 mm (mean ± SD). Volume parameters did not change significantly. In Group B, length of the AKS did not change significantly, EDVI increased significantly from 81.1 ±19.8 to 106.8±40.6 ml/m2 (p < 0.05); ESVI increased significantly from 41.7 ± 13.7 ml/m2 to 66.8 ± 37.9 ml/m2 (p < 0.01). In the acute stage, length of the AKS and volume parameters did not differ significantly between the two groups. In the chronic stage, AKS was significantly shorter (A: 73.2 ± 63.4 mm; 144.9 ± 59 mm (p < 0.0025)) and EF was significantly higher (A: 54.6 ±11.6%; B: 40.9 ±14.5% (p < 0.05)) in Group A. Peak CPK was lower in Group A (A: 1009 ± 827 U/l; B: 1324 ± 655 U/l), but this difference did not achieve statistical significance. Results of this pilot study suggest that transluminal recanalization in the early phases of acute myocardial infarction might result in limitation of myocardial injury. However, further research will be needed to improve the technique and to test its results.

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Resolution of an obstructive coronary lesion as demonstrated by selective angiography in a patient with transmural myocardial infarction

Cited by 47 publications

References 18 publications

Myocardial Infarction at a Young Age (Under 40 Years)

Myocardial Infarction at a Young Age (Under 40 Years)

Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

Initial experience with transluminal recanalization of the recently occluded infarct‐related coronary artery in acute myocardial infarction — Comparison with conventionally treated patients

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