Predictors of left ventricular function after acute myocardial infarction: effects of time to treatment, patency, and body mass index: the GUSTO-I angiographic experience.
BACKGROUND
Despite the significant survival benefit associated with successful reperfusion therapy for acute myocardial infarction, global indices of outcome left ventricular function, such as ejection fraction, have often demonstrated little or no improvement. Although these measurements are confounded by numerous clinical, physiologic, and angiographic variables, no comprehensive analysis of this issue in a large series of patients is available. We used the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) database to better understand this phenomenon by determining independent predictors of left ventricular function and their interplay with regard to outcome ventricular function and improvement in function during the initial postinfarction week.


METHODS
Ninety-minute and 5- to 7-day posttreatment global and regional indices derived from left ventriculograms were analyzed from a population of 676 patients. These observations were combined with clinical data to describe independent determinants of ventricular function outcome.


RESULTS
Clinical factors predictive of global and regional ventricular function as well as improvement in function between 90 minutes and 5 to 7 days included time to treatment, early infarct-related artery flow grade, and body mass index. These same factors contribute significantly to compensatory hyperkinesis of the noninfarct zone, which is critical to maintenance of global ventricular function during this time period.


CONCLUSIONS
The ventricular function benefits of early complete reperfusion after myocardial infarction are readily demonstrable after adjustment for multiple covariables and include (1) maintenance of global ventricular function and (2) prevention or delay in ventricular dilatation.
Lundergan
C F
CF
Cardiovascular Research Institute and the GUSTO-I Core Angiographic Laboratory, George Washington University, Washington, DC, USA. CLundergan@aol.com
Ross
A M
AM
McCarthy
W F
WF
Reiner
J S
JS
Boyle
D
D
Fink
C
C
Califf
R M
RM
Topol
E J
EJ
Simoons
M L
ML
Van Den Brand
M
M
Van de Werf
F
F
Coyne
K S
KS
D000368:Aged; D001783:Blood Flow Velocity; D015992:Body Mass Index; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014654:Vascular Patency; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D015646:Ventriculography, First-Pass