Variability of myocardium at risk for acute myocardial infarction

Kyle W. Klarich, Timothy F. Christian, Stuart T. Higano, Raymond J. Gibbons

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12 Scopus citations


The objective of this study was to assess the variability in myocardium at risk and relate this to coronary angiographic variables. One hundred ninety-seven patients with ≥1-mm ST-segment elevation in 2 contiguous electrocardiographic leads, without prior myocardial infarction, were injected with technetium-99m sestamibi acutely before reperfusion therapy. The perfusion defect was quantified to determine myocardium at risk for infarction. Patients underwent coronary angiography to determine the infarct- related artery and to classify the occlusion as proximal or not proximal. Collateral and anterograde (Thrombolysis In Myocardial Infarction [TIMI] trial) flow were assessed in a subset of 83 patients with angiography before direct angioplasty. Myocardium at risk for infarction in the distribution of the left anterior descending coronary artery was significantly greater (p <0.0001) than that in the circumflex or right coronary artery. In the left anterior descending coronary artery distribution, myocardium at risk for infarction was significantly larger for proximal occlusions (p <0.0001). There was a trend toward greater myocardium at risk for infarction of proximal occlusions (p = 0.14) of the left circumflex but not for proximal occlusions in the right coronary artery distribution (p = 0.47). Multivariate analysis revealed that the infarct-related artery (p <0.0001), TIMI flow (p = 0.0002), and proximal location (p = 0.09) in the infarct-related artery were independent predictors of myocardium at risk for infarction. Thus, infarct- related artery, TIMI flow, and proximal location of occlusion in the infarct- related artery influence the myocardium at risk for infarction, which is highly variable for given location of occlusion.

Original languageEnglish (US)
Pages (from-to)1191-1195
Number of pages5
JournalAmerican Journal of Cardiology
Issue number8
StatePublished - Apr 15 1999

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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