Comparison of left ventricular function and contractile reserve after successful recanalization by thrombolysis versus rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction.
To determine how coronary reperfusion affects rest and exercise ventricular function after acute myocardial infarction (AMI), 63 patients with a patent infarct artery after intravenous thrombolytic therapy (lysis) were compared with 27 patients who failed thrombolysis but had successful acute recanalization by percutaneous transluminal coronary angioplasty (PTCA) as a "rescue" procedure. Contrast ventriculography was performed acutely and on day 7. Resting radionuclide ventriculography was performed at 24 hours and repeated with exercise on day 30. There were no differences in global ejection fraction (EF) between the 2 groups during acute contrast ventriculography. However, by 24 hours, the EF had deteriorated in the rescue group (40 +/- 17 vs 49 +/- 11% in the lysis group, p less than or equal to 0.05). No improvement occurred in either group on day 7. By day 30, an improvement in resting radionuclide EF 5.9 +/- 1.9% occurred in rescue patients and the difference between rescue and lysis groups was no longer significant (46 +/- 14 vs 50 +/- 11%, p = 0.12). A normal (greater than or equal to 5%) increase in EF with exercise occurred in 64%, with either normal or exercise-enhanced regional wall motion present in 67% of patients. A significant increase in EF occurred within the rescue group, from 46 +/- 14% at rest to 50 +/- 15% at peak exercise (p less than or equal to 0.0005). The EF increased with exercise from 50 +/- 11 to 58 +/- 15% in the lysis group (p less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Grines
C L
CL
Department of Internal Medicine, University of Michigan, Ann Arbor.
O'Neill
W W
WW
Anselmo
E G
EG
Juni
J E
JE
Topol
E J
EJ
D000800:Angioplasty, Balloon; D005080:Exercise Test; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005082:Physical Exertion; D012146:Rest; D013318:Stroke Volume
D005343:Fibrinolytic Agents