RESUMO
CONDENSED ABSTRACT: To investigate the predictive value of clinical data for infarction-related artery (IRA) occlusion and multivessel coronary disease in postinfarction angina (PIA), we studied 181 consecutive patients presenting PIA following a first uncomplicated ST elevation AMI. Multivariate analysis showed ECG changes during PIA and the absence of thrombolytic therapy as independent predictors of IRA occlusion. Independent clinical predictors of multivessel coronary disease were age, previous history of angina and the number of cardiovascular risk factors. We conclude that reversible ECG changes during PIA correlated to IRA occlusion but failed to predict a multivessel coronary disease. AIM: To identify clinical variables predictive of infarction-related artery (IRA) occlusion and multivessel coronary disease in patients with postinfarction angina pectoris (PIA) after a first uncomplicated acute myocardial infarction (AMI). METHODS: We studied 181 consecutive patients with PIA following a first uncomplicated AMI. Clinical variables included cardiovascular risk factors, clinical history of angina before the event of inclusion, use of thrombolytic therapy in the previous AMI, ST-T changes during PIA, time to onset, number of episodes and delay to angiography after PIA. Angiographic variables were IRA TIMI flow, number of diseased vessels and ventricular function. RESULTS: The IRA was occluded in 67 patients with PIA (37.0%). Reversible ECG changes during PIA were detected in 121 patients (67.0%): 79 cases (43.6%) with ST/T elevation and 42 cases (23.2%) with ST/T depression. Multivariate logistic regression analysis showed ECG changes during PIA (OR 3.12 CI 95% 1.48-6.54, p<0.01) and the absence of thrombolytic therapy (OR 2.21 95% CI 1.11-4.43, p<0.05) as independent predictors of IRA occlusion. We found multivessel coronary disease in 89 patients (49.2%) without any correlation to ECG changes during PIA. Independent clinical predictors of multivessel coronary disease were age (OR 1.03 95% CI 1.01-1.06, p<0.05), previous history of angina (OR 2.37 95% CI 1.06-5.28, p<0.05) and the number of cardiovascular risk factors (OR 1.37 95% CI 0.97-1.92, p=0.07). CONCLUSIONS: ECG changes during PIA was correlated to IRA occlusion in spite of previous thrombolytic therapy but failed to predict a multivessel coronary disease in our patients.
Assuntos
Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Reestenose Coronária/diagnóstico , Reestenose Coronária/epidemiologia , Infarto do Miocárdio/complicações , Adulto , Distribuição por Idade , Angina Pectoris/etiologia , Angioplastia Coronária com Balão/métodos , Estudos de Coortes , Angiografia Coronária , Ponte de Artéria Coronária , Reestenose Coronária/etiologia , Eletrocardiografia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Análise de Sobrevida , Terapia Trombolítica/métodosRESUMO
We report our clinical experience in a single centre with 7 cases of atrial septal aneurysm (ASA) diagnosed by transthoracic echocardiography (TTE) between 1989-1996. They did not present any clinical event compatible with cardiogenic embolism after a five years mean follow-up period. ASA is recognized as a potential source of cardiogenic embolism [2] based on some retrospective and selection biased studies.
