J Korean Soc Echocardiogr.  1994 Dec;2(2):129-135. 10.4250/jkse.1994.2.2.129.

The Effects of Late Angioplasty of Infarct Related Artery on Left Ventricular Remodeling in Acute Myocardial Infarction

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea.

Abstract

BACKGROUND
Acute early reperfusion of infarct-related artery was most important predictor of survival in patients with acute myocardial infarcton(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 impartant 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 patients(mean 6.8 days after onset). LV volume and EF was measured by echocardiography 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±9.0%, −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 Group I patients, significant lower percent change in EDV and ESV than group II patients(p=0.01).
CONCLUSION
Late mechanical reperfusion with PTCA of residual significant stenosis of infarct-related artery tend to reduce subsequent left ventricular dilatation.

Keyword

Remodeling; Late percutaneous transluminal coronary angioplasty

MeSH Terms

Angioplasty*
Anterior Wall Myocardial Infarction
Arteries*
Constriction, Pathologic
Dilatation
Echocardiography
Follow-Up Studies
Humans
Myocardial Infarction*
Reperfusion
Thrombolytic Therapy
Ventricular Remodeling*

Figure

  • Fig. 1. The percent changes of EDV, ESV and EF in group I and Group II. ∗p-value<0.05


Reference

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