Myocardial Viability in Patients With Q Wave

Background. Coronary revascularization in patients with persistent angina after myocardial infarction reduces the incidence of recurrent angina pectoris and myocardial infarction and improves left ventricular function. The results of revascularization after a Q wave myocardial infarction when there is no residual ischemia may depend on myocardial viability. Methods and Results. To determine whether there was viable myocardium in the infarct area in the absence of clinical and scintigraphic evidence of myocardial ischemia, 15 asymptomatic patients with a Q wave myocardial infarction, no redistribution on stress 20TI test, and single-vessel disease (>70% stenosis) with persistent anterograde blood flow were randomized to percutaneous transluminal coronary artery angioplasty (PTCA) or conservative medical treatment. After 2 months of follow-up, mean coronary blood flow measured by Doppler catheter in the infarct-related artery was higher in the PICA treatment group (33±6 ml/min, n=8) than in the conservative treatment group (16±4 ml/min, n=7;p<0.05 between groups). The 2`FTI pathological-to-normal ratios measured on postexercise images did not change in patients treated conservatively during the follow-up period (A=+1 1+2 2%; NS from baseline) but increased significantly in patients treated by PTCA (A=+8.5±2.3%; p<0.01 from baseline; p<0.05 between groups). Segmental wall motion improved on left ventricular angiography 2 months after PTC