Influence of residual antegrade coronary blood flow on the long-term prognosis of medically treated patients with myocardial infarction and single-vessel disease.

We assessed the influence of residual antegrade coronary perfusion on long-term mortality and morbidity in 262 patients (256 men and 6 women, aged 52.3 +/- 9.8 years) with medically treated old myocardial infarction and single-vessel disease who were followed for 117.0 +/- 39.8 months. Partial or complete antegrade coronary perfusion of the infarct artery was present in 165 patients (group I); no or minimal antegrade perfusion of the infarct artery was present in 97 patients (group II). There was no significant difference in survival between group I (5-year survival rate, 96.9% and 10-year survival rate, 90.7%) and group II (93.8% and 92.7%, respectively). There was also no significant difference in the event free survival rate between group I (5-year, 92.6% and 10-year, 79.7%) and group II (89.5% and 74.8%, respectively). The extent of left ventricular dysfunction was an important determinant of prognosis: 10-year survival rates in patients with ejection fractions of > 60%, 40-60% and < 40% were 94.8%, 90.6% and 74.8%, respectively. In the majority of patients the subsequent cardiac events were related to the progression of atherosclerosis in previously nonstenotic coronary arteries. Thus the presence or absence of residual antegrade coronary flow in the chronic phase of myocardial infarction did not significantly influence the long-term prognosis of patients with single-vessel disease.