[Transmural anterior wall infarct with isolated disease of the anterior interventricular ramus. Long-term prognosis in relation to the degree of stenosis and location].

We examined the long-term prognosis in 213 survivors of the acute phase of a transmural anterior myocardial infarction with single vessel disease. All patients (pts) had undergone coronary angiography ad exercise testing at a mean interval of 6 months after myocardial infarction. 117 pts had a single lesion in the proximal LAD; 96 pts had a lesion after the first septal branch. The mean follow-up time was 4.5 years. The annual mortality for the whole group was 1.3%; 77% of all deaths occurred in pts with a greater than or equal to 75% proximal LAD lesion. The annual mortality of this subgroup was 2.75%--significantly higher than the 0.5% annual mortality in the remainder (p less than 0.003). Exercise-induced angina was of prognostic importance only in pts with greater than or equal to 75% proximal LAD lesions (annual mortality 7.25% in this small subgroup). None of the patients with angina and a lesion after the first septal branch died during follow-up. The degree and the location of the stenosis are of prognostic importance even after transmural myocardial infarction. Exercise-induced angina In pts with 1-VD after transmural anterior myocardial infarction is associated with a poor prognosis if it occurs in those with a greater than or equal to 75% stenosis in the proximal LAD. These results may help in the decision-making process for transluminal angioplasty or bypass surgery.