Clinical implication of persistent ischemic chest pain on admission in patients with late reperfused acute myocardial infarction

Object. Although previous studies reported that late reperfusion might prevent left ventricular dilation after acute myocardial infarction (AMI), implication of persistent ischemic chest pain on admission remains to be investigated. This study was undertaken to assess the implication of persistent ischemic chest pain on in-hospital outcome and left ventricular function after late reperfused AMI. Methods and Patients. We studied 63 patients with a first anterior AMI who underwent percutaneous coronary intervention 6 to 24 hours (11.2 ± 4.5 hours) after the onset. Of 63 patients, 48 (76%) had persistent ischemic chest pain on admission. Results. Incidence of in-hospital death, reinfarction or congestive heart failure was similar between the 2 groups. Pretreatment left ventricular ejection fraction and end-diastolic volume were similar between the 2 groups. Predischarge angiography was performed at 17 ± 5 days after the onset. Late reperfusion prevented the dilation of left ventricular end-diastolic volume in patients with chest pain (78 ± 12 to 75 ± 17 ml/m², p = 0.15), but did not in those without (75 ± 20 to 93 ± 28 ml/m², p=0.03). A multivariate analysis revealed that absence of persistent ischemic chest pain was an independent predictor of predischarge left ventricular end-diastolic volume > 100 ml/m² (odds ratio 0.10, p=0.04). Conclusions. Our data demonstrated that absence of persistent ischemic chest pain appears to be a simple and reliable marker which predicts left ventricular dilation after late reperfused AMI.