Coronary and left ventricular angiographic anatomy and prognosis of survivors of first acute myocardial infarction

To relate coronary anatomy and left ventricular function to prognosis, 197 of 269 consecutive survivors of a first myocardial infarction (MI) ≤ 60 years old underwent prospective cardiac catheterization a median of 2 weeks after admission and were followed up for a median of 24 months (range 12 to 61). Seventy-two patients were excluded from angiography because of early death (9), severe noncoronary disease (44), MI complications (6), or patient refusal (13). The prevalence of multivessel disease was low (30%) and unrelated to the site of MI or presence of Q waves but was increased in patients with previous angina pectoris (p = 0.05) or those in Killip class II or III (p = 0.02). There were only 8 deaths from heart disease. The survival rate at 12 months was 97 ± 1% and at 24 and 36 months, 95 ± 2%. Nineteen patients underwent coronary revascularization surgery. As the number of deaths was small, the differences in survival between patients with single or multivessel disease and normal or depressed ejection fractions failed to reach significance. Survivors of a first MI ≤ 60 years old have a low prevalence of multivessel disease and a good prognosis.