BACKGROUND: The value of coronary reperfusion resulting from Thrombolysis and/or coronary angioplasty in patients with evolving myocardial infarction has been rigorously evaluated and improved left venticular function and short-term survival rates have been demonstrated consistently in controlled studies. Benefits from delayed coronary angioplasty at 7-10 days after onset of acute myocardial infarction (AMI) without thrombolysis remains unclear. In order to assess the effect of delayed reperfusion in infarct-related artery(IRA), we analyzed the restenosis rate of IRA after successful coronary angioplasty and the change of left ventricular function at late follow-up angiogram. METHOD: Coronary angioplasty in 69 lesions of 55 patients(M/F:48/7, mean age 53 years) with acute myocardial infarction(AMI) were performed at 7-10 days after onset of AMI and follow-up coronary angiogram (25 lesions of 20 pts) with left ventriculogram were obtained at means 5.1 months(range 4-6 months) after angioplasty. Restenosis rate of dilated infaret-related arteries and the changes of left ventricular function after angioplasty were evaluated. RESULTS: The overall procedural success rate of delayed elective coronary angioplasty in patients with AMI was 86% with a higher success rate in subtotally occluded vessel(98%) than in the occluded IRA(64%). Complications included acute closure after large dissection in 1(1.6%) and on -hospital mortality due to cardiogenic shock in 1(1.8%). Angiographically restenosis rate of IRA was 65% at mean 5.1 months follow-up, which was relatively higher than that after non-IRA angioplasty in AMI(25%) and in patients with angina(24%). Left ventricular ejection fraction improved significantly from 47.2+/-12.7% to 58.8+/-8.6%(P<0.05) at follow-up. Patients who had a patent IRA at follow-up had a restenotic IRA at follow-up had no statistically significant improvement in EF(table 3). Patients with a left anterior descending artery(LAD) lesion had lower mean immediate EFs than patients with right coronary artery lesion, however the degree of improvement in EF at follow-up was more significant in patients with LAD lesion. CONCLUSIONS: Delayed elective angioplasty of IRA at 7-10 days after onset of AMI was relatively safe and had comparable procedural success rate. Higher restenosis rate(65%) of IRA at follow-up appeared to be related, at least on part, to the endothelial dysfunction after ischemic-reperfusion injury and clinically unstable status. Left ventricular function improved significantly after angioplasty at follow-up. Recovery of left ventricular function might be reated to whether or not the IRA had an angiographically restenosis at follow-up.
Angioplasty* ; Arteries ; Coronary Vessels ; Follow-Up Studies* ; Humans ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Reperfusion ; Shock, Cardiogenic ; Stroke Volume ; Survival Rate ; Ventricular Function, Left

The authors analized statistically 403 cases of C.N.S. tumors confirmed by pathology in the boundary of Daegu city and Kyungbook province from January 1984 to December 1986. The results were as follows: 1) The each cases of male and female were 220(54.6%) and 183(45.4%). 2) Intracranial tumors were 288 cases(71.5%), spinal tumors 75(18.6%), and others 40(9.9%). 3) Numbers of C.N.S. tumors were 8.7/100,000 population in city and 6.3/100,000 in country. 4) Among the intracranial tumors, glioma(30.9%) was the most common and followed by meningioma(16.3%) and metastatic tumor(8.7%). Among the spinal tumors, metastatic tumors was 34.6%, neurofibroma 30.7%, and meningioma 5.3%. 5) The majority of intracranial tumors were found in supratentorial region(76.3%), in which area frequency of tumor incidence were as follows; glioma, meningioma, metastatic tumor. Among the infratentorial area(22.6%), the sequence of tumor incidence were glioma, medulloblastoma, and neurilemmoma, 6) Tumors predominantly in male were oligodendroglioma(2:1), metastatic tumor(1.8:1), and medulloblastoma(1.7:1), and in female were meningioma(1:2), neurilemmoma(1:1.7), and pituitary tumor(1:1.5). 7) Peak age incidence of glioma, meningioma, and neurilemmoma were from 40 to 60 years, pituitary tumor and oligodendroglioma were 30 to 50 years, craniopharyngioma and ependymoma were around 10 years old, and metastatic tumor was 50 to 70 years old. 8) In the spinal tumors, the most favorable site of longitudinal axis was thoracic area(62.7%) and transverse location was epidural space(45.3%). 9) The most common site of metastatic tumor were came from lung(29.1%) in brain metastasis and prostate(19.2%) in spine.
Aged ; Axis, Cervical Vertebra ; Brain ; Brain Neoplasms ; Central Nervous System Neoplasms* ; Central Nervous System* ; Child ; Craniopharyngioma ; Daegu ; Ependymoma ; Female ; Glioma ; Humans ; Incidence ; Male ; Medulloblastoma ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma ; Neurofibroma ; Oligodendroglioma ; Pathology ; Pituitary Neoplasms ; Spine