Increasingly well-preserved left ventricular function in hospital survivors with acute myocardial infarction: effect of early and complete reperfusion strategy on left ventricular remodeling.
BACKGROUND
Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI.


RESULTS
The study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55+/-14, 58+/-13, 59+/-13, 61+/-13%, p<0.001; 98+/-30, 94+/-27, 90+/-31, 76+/-27 ml/m2, p<0.0001). Multiregression analysis revealed that shortening of the door-to-Thrombolysis In Myocardial Infarction (TIMI)-3 time (time interval from arrival at the emergency room until patients achieved TIMI-3 flow) and achieving substantial TIMI-3 flow were independent predictors for LV remodeling.


CONCLUSIONS
Although this was a retrospective analysis, the results demonstrated that the change in reperfusion therapy aiming at complete reperfusion at an earlier stage after AMI onset has contributed to improving post-MI remodeling.
Tani
Shigemasa
S
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. tanishigem@yahoo.co.jp
Nagao
Ken
K
Watanabe
Ikuyoshi
I
Kikushima
Kimio
K
Watanabe
Kazuhiro
K
Anazawa
Takeo
T
Kawamata
Hirofumi
H
Tachibana
Eizo
E
Matsumoto
Michiaki
M
Kumabe
Takamichi
T
Kanmatsuse
Katsuo
K
Kushiro
Toshio
T
D000208:Acute Disease; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013927:Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*