[Does the treatment delay influence reperfusion efficacy and short- and long-term left ventricular function in patients with anterior myocardial infarction treated with primary coronary angioplasty?].
The benefit of thrombolysis in acute myocardial infarction (AMI) is time dependent, but there is lack of evidence of such a close correlation in patients undergoing primary percutaneous transluminal coronary angioplasty (pPTCA). The aim of this study was to evaluate the importance of delay of treatment for myocardial reperfusion and early and late ventricular function in patients with anterior AMI treated with pPTCA.


METHODS
106 consecutive patients (76 men, 30 women, age 63 +/- 11 years) treated with pPTCA for anterior AMI was included in this study. We evaluated angiographic (myocardial blush grade (MBG), TIMI flow, corrected TIMI frame count) and electrocardiographic (resolution of ST segment elevation--nST) markers of myocardial reperfusion. Echocardiography was performed 3 and 180 days after pPTCA. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction were calculated. Patients were divided into three groups: group A (41 pts.) reperfused within 3 hours, group B (40 pts.) reperfused between 3-6 hours, group C (25 pts.) reperfused between 6-12 hours from symptoms onset.


RESULTS
MBG 0-1 (lack of myocardial reperfusion) was significantly more common in group B and C, compared with group A (p = 0.002). The incidence of nST was higher in group A (p < 0.0001). The EF after 3 days (p = 0.03) and after 6 months (p = 0.04) was better in group A in comparison to group C. There was not significant difference in EDV after 3 days, but after 6 months EDV was significantly higher in group C (p = 0.02).


CONCLUSIONS
The delay of treatment over 3 hours is associated with decreasing of myocardial reperfusion efficacy and deterioration of the early and late LV function.
Araszkiewicz
Aleksander
A
I Klinika Kardiologii AM im. Karola Marcinkowskiego, Poznaniu. aaraszkiewicz@interia.pl
Lesiak
Maciej
M
Grajek
Stefan
S
Mularek-Kubzdela
Tatiana
T
Oko-Sarnowska
Zofia
Z
Trojnarska
Olga
O
Popiel
Małgorzata
M
Cieśliński
Andrzej
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D011044:Poland; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left