LEFT-VENTRICULAR DYSFUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION - RESULTS OF A PROSPECTIVE MULTICENTER STUDY

[摘要] In a multicenter prospective study of 866 patients who survived the coronary care unit phase of an acute myocardial infarction, variables reflecting left ventricular function were examined to assess their impact on 2 yr survival. Single variables that reflected left ventricular dysfunction before infarction and in the acute and recovery phases were, respectively, history of prior myocardial infarction, rales in the coronary care unit dichotomized at greater than bibasilar and predischarge radionuclide ejection fraction dichotomized at < 0.40. When combined in a stepwise fashion, patients lacking these 3 risk characteristics had a 2 yr 4.2% mortality rate, whereas patients possessing all 3 characteristics had a 45% mortality rate. Rales in the coronary care unit and predischarge ejection fraction act independently, and each contributes to mortality. Patients (52) with advanced rales but an ejection fraction of .gtoreq. 0.40 had a 21% mortality rate. Similarly, 208 patients with few rales but an ejection fraction of < 0.40 had a 15% mortality rate. The mortality risk imposed by those factors that assess permanent left ventricular damage is independent of and additive to the mortality risk contributed by dynamic, acute phase dysfunction. These data fit the hypothesis that acute phase dysfunction is, in part, due to transient ischemia that, on reversal, can restore function toward normal. Assessment of left ventricular function during the acute and recovery phases of myocardial infarction is necessary to define prognostic characteristics of an individual patient and the particular importance is the identification of patients whose postinfarction course is consistent with reversible ischemia.