PMID- 17532390
OWN - NLM
STAT- MEDLINE
DCOM- 20070608
LR  - 20071115
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 83
IP  - 6
DP  - 2007 Jun
TI  - Impact of lateral wall myocardial infarction on outcomes after surgical 
      ventricular restoration.
PG  - 2017-27; discussion 2027-8
AB  - BACKGROUND: Surgical ventricular restoration (SVR) attempts to reverse negative 
      ventricular remodeling after anterior myocardial infarction (MI). However, the 
      impact of lateral wall MI (LMI) on SVR outcomes is unknown. METHODS: We 
      retrospectively reviewed SVR patients between January 2002 and December 2005. 
      Patients were grouped into those with and without LMI. Lateral wall myocardial 
      infarction patients were further subdivided into those with anterior-lateral and 
      anterior-inferior-lateral MI. Extent of LMI was assessed intraoperatively as less 
      than 25%, 25% to 49%, 50% to 75%, and more than 75% of the lateral wall. 
      Follow-up was 100%. RESULTS: Seventy-eight patients underwent SVR; all had 
      anterior MI. Forty-one percent (32 of 78) had LMI; 19% (6 of 32) had 
      anterior-lateral MI; and 81% (26 of 32) had anterior-inferior-lateral MI. The 
      remaining 59% (46 of 78) comprised the no-LMI group. Among LMI patients, 6% (2 of 
      32) had more than 75% involvement of the lateral wall. Lateral wall myocardial 
      infarction patients were more likely to be New York Heart Association (NYHA) 
      class IV preoperatively. There were 2 operative deaths in the LMI group. Surgical 
      ventricular restoration significantly improved ejection fraction and end-systolic 
      volume index for patients with and without LMI. Sixty-three percent of patients 
      (20 of 32) with LMI and 83% of patients (38 of 46) without LMI improved to NYHA 
      class I/II at follow-up. Three-year Kaplan-Meier survival for LMI patients was 
      67%, which trended toward a decreased survival versus patients without LMI (85%; 
      p = 0.18). Three-year Kaplan-Meier survival for anterior-lateral MI patients was 
      100%, and for anterior-inferior-lateral MI patients, it was 60%. Lateral wall 
      myocardial infarction involving >50% of the lateral wall was a significant 
      predictor of mortality (odds ratio = 8.3, 95% confidence interval: 1.3 to 54.1, p 
      = 0.03). CONCLUSIONS: Cardiac function is improved after SVR for patients with 
      and without LMI. However, anterior-inferior-lateral MI and LMI involving 50% or 
      more of the lateral wall may predict mortality. Our results should prompt further 
      investigation to determine the role of SVR for patients with LMI.
FAU - Patel, Nishant D
AU  - Patel ND
AD  - Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, 
      Maryland 21287, USA.
FAU - Williams, Jason A
AU  - Williams JA
FAU - Nwakanma, Lois U
AU  - Nwakanma LU
FAU - Weiss, Eric S
AU  - Weiss ES
FAU - Conte, John V
AU  - Conte JV
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - *Cardiac Surgical Procedures/mortality
MH  - Female
MH  - Heart Failure/etiology/physiopathology/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/classification/*complications/physiopathology
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - *Ventricular Remodeling
EDAT- 2007/05/29 09:00
MHDA- 2007/06/09 09:00
CRDT- 2007/05/29 09:00
PHST- 2006/11/11 00:00 [received]
PHST- 2007/02/06 00:00 [revised]
PHST- 2007/02/07 00:00 [accepted]
PHST- 2007/05/29 09:00 [pubmed]
PHST- 2007/06/09 09:00 [medline]
PHST- 2007/05/29 09:00 [entrez]
AID - S0003-4975(07)00387-6 [pii]
AID - 10.1016/j.athoracsur.2007.02.026 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2007 Jun;83(6):2017-27; discussion 2027-8. doi: 
      10.1016/j.athoracsur.2007.02.026.