Emergent angioplasty prevents left ventricular dilation in patients with acute anterior wall myocardial infarction and cardiogenic shock.
BACKGROUND
Percutaneous transluminal coronary angioplasty (PTCA) reduces in-hospital mortality and improves long-term outcome in patients with acute myocardial infarction (MI) complicated by cardiogenic shock. However, no study has evaluated the effects of different reperfusion therapies on left ventricular (LV) dimension and cardiac function in long-term survivors of MI with cardiogenic shock.


OBJECTIVE
We investigated the effects of PTCA on the development of LV dilation in patients who survived MI complicated by cardiogenic shock.


METHODS
We studied 34 patients with a first MI and cardiogenic shock in whom two-dimensional echocardiography was performed immediately after admission and 1 month after infarction. Group A consisted of 17 patients who underwent emergent PTCA during the acute phase of MI, and Group B consisted of 17 patients who did not undergo PTCA. We also studied 119 patients with a first uncomplicated acute anterior MI, including 53 who underwent PTCA (Group C) and 66 who did not (Group D). The length and wall thickness of the infarcted and noninfarcted endocardial segments were determined immediately after MI and 1 month later, and LV ejection fraction (LVEF) was measured during the chronic phase.


RESULTS
The lengths of the infarcted and noninfarcted endocardial segments were significantly greater in Group B than in the other three groups (p < 0.05). The LVEF was significantly lower in Group B than in the other three groups (p < 0.05).


CONCLUSIONS
We conclude that PTCA performed in patients during the acute phase of MI complicated by cardiogenic shock lowers in-hospital mortality and prevents both LV dilation and a decrease in LVEF.
Iwamori
K
K
Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Sakata
K
K
Kurihara
H
H
Yoshino
H
H
Ishikawa
K
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018709:Statistics, Nonparametric; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000517:prevention & control*
D013794:Thallium Radioisotopes