923-7 Infarct Artery Patency does not Prevent LV Remodeling

Prior studies suggest that an occluded infarct-related artery (IRA) is a risk factor for progressive LV remodeling following AMI. The purpose of this study was to determine whether LV dilatation also occurred in patients with patent IRAs. Serial echocardiograms at baseline and at 1 year (1 Y) were obtained in 420 SAVE patients, of whom 185 (44.0%) had a pre-randomization cardiac catheterization reviewed by a central Core laboratory. A patent IRA was present in 145 (78.4%) of these patients with both catheterization and echo data. Catheterization occurred an average of 4.4 ± 4.2 days post AMI. Patent IRA patients were 55 ± 11 years old, and 76.6% male. Ejection fraction was 31.3% ± 5.8. Echo LV size echo was expressed as end diastolic area (EDA). and end systolic area (ESA). LV dilatation occurred in the overall group (baseline EDA 69.1 ± 11.8, 1 Y 73.3 ± 13.1, P l 0.001; baseline ESA 48.6 ± 10.9, 1 Y 53.1 ± 14.2, P l 0.001). Randomization to placebo (PLA, n = 67) or captopril (CAP, n = 78) occurred 3 – 16 days post AMI. There was a trend for less LV dilatation in captopril-treated patients. PLA CAP P EDA change 5.6 ± 8.1 3.1 ± 7.7 0.06 ESA change 5.6 ± 7.8 3.6 ± 9.0 0.15 Although the occluded IRA is a known risk factor for LV remodeling, this study demonstrates that LV enlargement can occur in patients with patent IRAs.