Superimposition of Transmural Infarction Following Acute Subendocardial Infarction

Kossowsky, Warren A.; Mohr, Brian; Rafii, Shahrokh; Lyon, Alan F.

doi:10.1378/chest.69.6.758

Cited by 32 publications

(5 citation statements)

References 20 publications

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“…considered the Sb type as a transitional form of the Tr type (2). However, the Sb type with severe coronary atherosclerosis and its characteristic clinical course suggests that this type is an independent disease, as has already reported by other investigators (3)(4)(5).…”

supporting

confidence: 55%

“…Two types of transmural (Tr) and subendocardial (Sb) infarction are caused by this complicated pathogenesis (1). Some investigators have considered the Sb type as a transitional form of the Tr type (2). However, the Sb type with severe coronary atherosclerosis and its characteristic clinical course suggests that this type is an independent disease, as has already reported by other investigators (3)(4)(5).…”

mentioning

confidence: 68%

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Characterization of Transmural and Subendocardial Infarction by Typing and Grading of Ischemic Lesions in Autopsied Human Hearts

Kuwao

Kameya

Kasai

et al. 1992

Acta Pathologica Japonica

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Two types of myocardial infarction, transmural and subendocardial, were macroscopically examined, and the gross and microscopic findings were correlated. The transmural type usually consisted of yellowish-brown coagulation necrosis in the center of an infarcted focus and coagulative myocytolysis at the marginal zone. The subendocardial type was characterized by coagulative myocytolysis throughout the entire focus. Wavy fiber and colliquative myocytolysis of non-specific ischemic lesions were seen only microscopically in both peripheral and subendocardial areas of infarcted foci. Coagulation necrosis was associated with obstructive thrombus formation in 79% of cases as a result of absolute ischemia in the transmural type. Coagulative myocytolysis was associated with obstruction by plaque hemorrhage in 27% of cases, and multivessel disease was frequently encountered in the subendocardial type due to insufficient blood supply. Based on histochemical and immunohistochemical examinations, the ischemic lesions were graded in descending order of coagulation necrosis, coagulative myocytolysis, wavy fiber, and colliquative myocytolysis. The close relation between coagulation necrosis and the transmural type as well as that of coagulative myocytolysis with the subendocardial type suggests two different pathogenetic mechanisms of transmural and subendocardial infarction. Acta Pathol Jpn 42: 476-482, 1992.

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supporting

confidence: 55%

mentioning

confidence: 68%

Characterization of Transmural and Subendocardial Infarction by Typing and Grading of Ischemic Lesions in Autopsied Human Hearts

Kuwao

Kameya

Kasai

et al. 1992

Acta Pathologica Japonica

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“…Single-vessel dilatation was performed in 100 patients, including 16 multilesion dilatations in the same artery. Double artery dilatation was performed in 13 patients and triple artery dilatation in 1 (Table II).…”

Section: Resultsmentioning

confidence: 99%

“…Thirtyone patients develoIjed recurrent angina and of these, 5 underwent an elective bypass surge@ 168 (range 7 to 534) days after the initial procedure, 8 were controlled by pharmacologic therapy, and 18 underwent a repeat PTCA 120 [range 1 to 300) days after the initial pro&-dure. Success was achieved in redilating the artery in 16 patients.…”

Section: Resultsmentioning

confidence: 99%

Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction

Suryapranata¹,

Beatt²,

Feyter³

et al. 1988

The American Journal of Cardiology

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Despite initially favorable prognosis in patients with non-Q-wave acute myocardlal infarction (AMI), long-term mortality In thls subset of patients appears to be similar to or even greater than that In patients wlth Q-wave AMI. The relatively poor late prognosis is primarily due to a hlgh lncldence of unstable angina and recurrent AMI. Between January 1982 and January 1987, 114 patients with suitable coronary narrowing underwent percutaneous translumlnal coronary angkplasty (PTCA) for angina pectoris (present elther at rest or during mlld exertion, and despite optimal pharmacologic therapy), a median of 31 (range 2 to 382) days after a non-Q-wave AMI.

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“…The 'in-hospital' mortality and the incidence of arrhythmias and shock have shown a similar percentage in patients with nontransmural and transmural myocardial infarction [21,26,29], Concerning the anatomical status of coronary vessels, angiographic studies have not shown significant mor phologic differences between nontransmural and transmural infarction [10. 12, 23, 30], Although the long-term prognosis of NTMI is benign in terms of death from pump failure [16], the incidence of recurrent angina and arrhythmias following the acute episode is high [5,23,25,33], Further more, a later superimposition of transmural infarction following NTMI has been reported as a not infrequent event [16,23]. Thus, subjects suffering a NTMI may be considered as a 'miscellanea' of high-risk and mild-risk patients.…”

mentioning

confidence: 99%

Exercise Testing after Nontransmural Myocardial Infarction

et al. 1981

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In order to ascertain the prognostic value of exercise testing in patients suffering nontransmural myocardial infarction, 74 patients performed a bicycle-ergometric test 4 weeks after the onset of the illness. The test induced angina and/or ischemic changes of ECG in 33 (group B) patients and no ischemic abnormalities in 41 (group A) patients. Following the exercise testing, all the patients performed a similar supervised exercise training program. Group A patients increased both their maximal work capacity (MWC) (mean + 26.4%, P < 0.001) and their total work performed (TWP) (mean + 54.8%, p < 0.001). 1 patient suffered a new transmural infarction during the training period. Although group B patients similarly increased their MWC (mean + 16.0%, P < 0.001) and TWP (mean + 30.0%, p < 0.005), 1 patient died suddenly and 1 patient experienced a new transmural infarction during the training period. In addition, another 2 group B patients stopped their training program due to the onset of recurrent angina at rest. Coronary angiographic examination was performed on 20 patients of each group within 12 weeks of the acute nontransmural myocardial infarction. The percentage of normal coronary angiographic findings and single, double, triple coronary vessels disease was: group A: 30, 45, 20 and 15%; group B: 0, 10, 30 and 60%. During the 12-month follow-up period, 1 patient of group A had an aortic coronary bypass operation. In contrast, group B patients had many clinical events: 4 died suddenly, 7 suffered recurrent episodes of angina pectoris, 6 underwent an aortic coronary bypass operation, 2 developed left ventricular insufficiency. The data suggest that the results of the exercise testing, 4 weeks after a nontransmural myocardial infarction, have predictive value for atherosclerotic coronary involvement and can be useful to estimate the long-term prognosis of these patients.

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Superimposition of Transmural Infarction Following Acute Subendocardial Infarction

Cited by 32 publications

References 20 publications

Characterization of Transmural and Subendocardial Infarction by Typing and Grading of Ischemic Lesions in Autopsied Human Hearts

Characterization of Transmural and Subendocardial Infarction by Typing and Grading of Ischemic Lesions in Autopsied Human Hearts

Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction

Exercise Testing after Nontransmural Myocardial Infarction

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