Prognosis after acute myocardial infarction in patients with and without residual anterograde coronary blood flow.

The restoration of anterograde coronary flow during the hours to days after acute myocardial infarction (AMI) may be beneficial independent of an effect on left ventricular function. This study was done to assess the influence of residual anterograde coronary perfusion on long-term morbidity and mortality in patients after AMI. Over a 10-year period, 179 subjects (132 men, 47 women, aged 25 to 66 years) with infarction and angiographic evidence of disease of only 1 coronary artery were followed for 47 +/- 29 (mean +/- standard deviation) months. All were receiving medical therapy. Sixty-four patients had partial or complete anterograde perfusion of the infarct artery (group I), whereas the other 115 had no or minimal anterograde perfusion (group II). The 2 groups were similar in age, sex, risk factors for atherosclerotic cardiovascular disease, duration of follow-up, maintenance medications and left ventricular function. In group I, unstable angina and congestive heart failure each occurred in less than or equal to 10%, and none died. In marked contrast, the 115 patients in group II frequently had unstable angina (25%) and congestive heart failure (17%) (p less than or equal to 0.05 for both vs group I), and 21 (18%) died suddenly (p less than 0.001 vs group I). Thus, the incidence of long-term morbidity and mortality is greatly increased after AMI in patients without residual anterograde perfusion of the infarct-related coronary artery. In these patients, the restoration of partial or complete anterograde flow--pharmacologically or mechanically--may be beneficial even if it is accomplished hours to days after the acute event.