[Prognosis of patients with triple vessel disease and old myocardial infarction: relationship to the number of total coronary occlusions].

Patients with myocardial infarction (MI) and triple vessel coronary disease generally have poor prognoses. However, it is not known whether there are particular angiographic variables associated with the poor prognosis in MI patients with triple vessel disease. The angiographic variables for poor prognosis were investigated in 43 MI patients with triple vessel disease (32 men and 11 women, mean age 63 +/- 9 years) who were followed medically for a mean of 32 +/- 28 months. There were 13 cardiac deaths (30%) and 10 late-coronary artery bypass grafting (23%). Twenty patients were alive and well. The patients who died of cardiac causes had lower ejection fractions (42 +/- 18% vs 49 +/- 15%, p < 0.05), a higher prevalence of two vessel occlusion (77% vs 40%, p < 0.05), and a higher prevalence of coronary occlusion opposite the MI site (69% vs 25%, p < 0.01) when compared to survivors, although there were no significant differences in age, MI sites, or the prevalence of occlusion in the infarct-related artery. Multivariate analysis with the Cox proportional hazards model revealed that coronary occlusion opposite the MI site (hazards ratio 16.36) and an age of > or = 65 years (4.46) indicated a significantly high ratio. The hazard ratio of the ejection fraction and two vessel coronary occlusion were not significant. The poor prognosis of MI patients with triple vessel coronary disease may be related to impaired left ventricular function and to coronary occlusion opposite the MI site and greater age. This may have important clinical implications in the initial decision for interventional therapy.