[Early revascularization of the arteries not related to infarction improves regional and global function of the left ventricle after acute myocardial infarction].
OBJECTIVE
To evaluate if early interventions which increase flow in the non-infarct related arteries (NRA) could improve long-term ventricular function in the non-infarct (NI) area after an acute myocardial infarction (MI).


METHODS
We studied regional wall motion analyzed by the center-line method in two groups of patients with significant stenoses (> or = 70%) in the NRA after successful coronary reperfusion (chemical or mechanical thrombolysis). Group I (GI) consisted of 21 patients that were submitted to early (mean 14 days) complete surgical revascularization of both NRA and infarct related artery (IRA); the 12 group II (GII) patients underwent successful revascularization of the IRA only, with percutaneous transluminal coronary angioplasty (mean 6 days). Paired ventriculograms were obtained within 48 hours of the infarction and a mean of 17 months later.


RESULTS
NI area contractility in GI patients improved from -0.35 +/- 2.16 to +0.62 +/- 1.6sd/chord (p < 0.05), whereas in GII decreased from +0.54 +/- 1.78 to -0.66 +/- 1.72 sd/chord (p < 0.05), p < 0.05 between the groups at follow-up. Mean infarct area wall motion did not differ between the two groups: from -3.04 +/- 2.43 to 2.61 +/- 2.49 sd/chord in GI (p = NS), and from -2.68 +/- 2.54 to -2.93 +/- 2.35 sd/chord in GII (p = NS). Mean global left ventricular (LV) ejection fraction did not change in GII patients (0.72 +/- 0.09 and 0.67 +/- 0.12, p = NS), but significantly increased from 0.63 +/- 0.12 to 0.72 +/- 0.11 in GI patients (p < 0.01).


CONCLUSIONS
These data suggest that early revascularization of NRA with significant stenoses can improve not only the NI area regional contractility, but also the global LV function in the long-term follow-up of post MI patients treated with thrombolytic therapy.
Kalil Filho
R
R
Instituto do Coração do Hospital das Clínicas, FMUSP.
Forlenza
L M
LM
Soares
P R
PR
de Albuquerque
C P
CP
Bellotti
G
G
Pileggi
F
F
Tranchesi Júnior
B
B
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D016277:Ventricular Function, Left / Q000502:physiology*
A revascularização precoce das artérias não relacionadas ao infarto melhora a função regional e global do ventrículo esquerdo após o infarto agudo do miocárdio.