Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction.
OBJECTIVE
We sought to evaluate the importance of time in relation to treatment, time course and determinants of recovery of left ventricular (LV) function in patients with acute myocardial infarction (AMI) undergoing primary percutaneous transluminal coronary angioplasty (PTCA).


BACKGROUND
Myocardial salvage has been shown to be dependent on the time elapsed from the onset of AMI to reperfusion.


METHODS
Left ventricular function was evaluated at hospital admission, after angioplasty, at 24 h and 6 months by both echocardiography and angiography and at 1, 7, 30, 90 and 180 days by echocardiography in 101 consecutive patients.


RESULTS
Patients were allocated to three groups according to interval between symptom onset and angioplasty: <2 h (group A), 2 to 4 h (group B) and >4 h (group C). Patients in groups A and B showed a progressive improvement of LV function between day 7 and day 90, which became statistically significant at day 30 (p < 0.01). No LV function changes were noted in group C patients. Thrombolysis In Myocardial Infarction (TIMI) flow grade <3 at 24 h was not associated with any significant change in LV volume and function during the six-month follow-up period. Restenosis, when associated with TIMI flow grade 3 in the infarct-related vessel, did not influence LV function. Flow grade <3 of the infarct-related artery was not associated with any improvement of cardiac events independently from the time to treatment at the initial procedure.


CONCLUSIONS
Patients undergoing primary PTCA for AMI have a good recovery of LV function if TIMI flow grade 3 is restored within 4 h. Coronary angioplasty limits further remodeling of the LV in patients treated after 4 h.
Sheiban
I
I
Department of Internal Medicine, University of Torino, Ospedale San Giovanni Battista Molinette, Italy. isheiban@yahoo.com
Fragasso
G
G
Rosano
G M
GM
Dharmadhikari
A
A
Tzifos
V
V
Pagnotta
P
P
Chierchia
S L
SL
Trevi
G
G
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000378:metabolism; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology / Q000503:physiopathology* / Q000628:therapy*; D009206:Myocardium / Q000201:enzymology; D013997:Time Factors; D014654:Vascular Patency; D016277:Ventricular Function, Left
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form