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Abstract
Background
Acute early reperfusion of infarct-related artery was most important predictor of survival in patients with acute myocardial infarction(AMI). But. it is well accepted that the degree of left ventricular dilatation after an acute myocardial infarction is an important predictor of death at 1 year. The severity of residual stenosis of the infarct-related artery(IRA) was an important predictor of subsequent left ventricular remodeling after myocardial infarction. We evaluated the effect of late PTCA of an residual stenotic lesion of IRA on left ventricular dilatation and function.
Subjects and Methods
Twenty six patients with first acute anterior wall myocardial infarction were evaluated. All patients recieved immediate thrombolytic therapy(within 6hrs after AMI) and coronary angiogram (mean 1.8 days after onset). PTCA was performed successfully in eleven paticnts(mean 6.8 days after onset). LV volume and EF was measured by echocardiograpy at discharge and follow-up (mean 5.8 months after AMI onset).
Results
1) After thrombolytic therapy, degree of residual stenotic lesion of IRA was 78.9% in Group I and 75.7% in Group II. After PTCA, degree of residual stenosis was 25.5% in group I. 2) In the patients with treated by early thrombolysis with late PTCA(Group I). EDV change was from 85.7 ± 13.4ml at discharge to 82.8 ± 16.4ml at follow up. ESV change was 43.1 ± 12.4ml to 39.5 ± 15.4ml. EF change was 50.0 ± 6.4% to 53.2 ± 8.5%, and percent change in EDV. ESV and EF were –3.5 ± 9.()%. –8.7 ± 16.1% and 5.9 ± 12.3%. respectively. 3) In the patients with thrombolysis alone(Group II), EDV change was from 79.1 ± 16.4ml at discharge to 86.2 ± 21.5ml at follow up. ESV change was 42.0 ± 12.8ml to 46.1 ± 18.4ml, EF change was 47.2 ± 8.7% to 47.1 ± 9.5%. and percent change in EDV, ESV and EF were 9.1 ± 14.7%, 8.8 ± 12.1 % and 0.0± 13.1 %, respectively. 4) In Gruop I patients, significant lower percent change in EDV and ESV than group II patients(p=0.01)
References
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Table 1.
Baseline clinical characteristics of study patients
| Group I | Group II | |
|---|---|---|
| Numbers | 11 | 15 |
| Age(vrs) | 54 ± 8.4 | 57 ± 7.7 |
| Sex(M/F) | 9/2 | 12/3 |
| CKmax(U/I) | 1489 ± 879 | 1648 ± 930 |
| Perfusion score (LAD territory) | 8.2 ± 2.9 | 7.9 ± 4.3 |
Table 2.
Angiographic characteristics of study patients
| Group I | Group II | |
|---|---|---|
| Lesion(prox./mid.) | 7/4 | 10/5 |
| TIMI grade | 0/1/4/ 6 | 0/0/8/7 |
| 0/1/2/3 | 0/0/0/11∗ | |
| Stenosis (%) | 78.9 ± 10.5 | 75.7 ± 9.6 |
| 24.5 ± 4.7∗ |
Table 3.
Comparison of echocardiographic measurements in each group
| Group I | Group II | |
|---|---|---|
| EDV 1(ml) | 85.7 ± 13.4 | 79.1 ± 16.4 |
| EDV 2(ml) | 82.8 ± 16.4 | 86.2 ± 21.5 |
| Δ EDV(%) | –3.5 ± 9.0 | 9.1 ± 14.7∗ |
| ESV 1(ml) | 43.1 ± 12.4 | 42.0 ± 12.8 |
| ESV 2(ml) | 39.5 ± 15.4 | 46.1 ± 18.4 |
| Δ ESV(%) | –8.7 ± 16.1 | 8.8 ± 12.1∗ |
| EF 1(ml) | 50.3 ± 6.4 | 47.2 ± 8.7 |
| EF 2(ml) | 53.2 ± 8.5 | 47.1 ± 9.5 |
| Δ EF(%) | 5.9 ± 12.3 | 0.0 ± 13.1 |
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