Hyperoxemic perfusion of the left anterior descending coronary artery after primary angioplasty in anterior ST-elevation myocardial infarction.
OBJECTIVE
To assess left ventricle function recovery, ST-segment changes, and enzyme kinetic in ST-elevation myocardial infarction patients treated with intracoronary hyperoxemic perfusion (IHP) after primary percutaneous coronary intervention and compare them with the results obtained in control patients.


BACKGROUND
IHP has been shown to attenuate microvascular reperfusion injury, which may result in poor LV function recovery despite successful primary percutaneous coronary intervention.


METHODS
Twenty seven anterior ST-elevation myocardial infarction patients treated < or = 12 hr after symptom onset by primary percutaneous coronary intervention were subjected to selective IHP into the left anterior descending coronary artery for 90 min. They were compared with 24 anterior ST-elevation myocardial infarction control patients matched in clinical and angiographic characteristics and treated with conventional primary percutaneous coronary intervention. Left ventricular function recovery was evaluated by serial 2D contrast echocardiography.


RESULTS
Left anterior descending coronary artery recanalization was successful in all patients. After IHP (100% successful, duration 90 +/- 5.4 min), patients showed a 4.8 +/- 2.2 hr shorter time-to-peak creatine kinase release (P = 0.001), a shorter creatine kinase half-life period (23.4 +/- 8.9 hr vs. 30.5 +/- 5.8 hr, P = 0.006), and a higher rate of complete ST-segment resolution (78% vs. 42%, P = 0.01). A significant improvement of mean left ventricular ejection fraction (from (44 +/- 9)% to (55 +/- 11)%, P < 0.001) and wall motion score index (from 1.77 +/- 0.2 to 1.39 +/- 0.4, P < 0.001) was observed at 3 months in IHP patients only.


CONCLUSIONS
After successful primary coronary intervention, IHP is associated with significant left ventricular function recovery when compared to conventional treatment. Enzyme kinetic and ST-segment changes suggest faster and more complete microvascular reperfusion and may explain the salutary effects of this new therapy on left ventricular function.
Trabattoni
Daniela
D
Centro Cardiologico Monzino IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
Bartorelli
Antonio L
AL
Fabbiocchi
Franco
F
Montorsi
Piero
P
Ravagnani
Paolo
P
Pepi
Mauro
M
Celeste
Fabrizio
F
Maltagliati
Anna
A
Marenzi
Giancarlo
G
O'Neill
William W
WW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003331:Coronary Vessels; D052279:Creatine Kinase, MB Form / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D018496:Hyperoxia; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D010100:Oxygen / Q000008:administration & dosage / Q000627:therapeutic use*; D012996:Solutions; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D012996:Solutions; D052279:Creatine Kinase, MB Form; D010100:Oxygen