Endothelial-dependent vasoconstriction in the infarct-related artery early after myocardial infarction is smaller following primary angioplasty than thrombolytic therapy.
OBJECTIVE
In patients with ST-elevation acute myocardial infarction treated by thrombolysis, both early endothelial dysfunction and long-term improvement in the infarct-related artery have been reported. Our aims were to assess the degree of endothelial dysfunction present after primary angioplasty and to compare it with that after thrombolysis.


METHODS
Endothelial function was assessed 9 days after infarction by infusing acetylcholine, at an increasing concentration, and subsequently nitroglycerine into the infarct-related artery in 16 patients who had undergone primary angioplasty and bare-metal stent implantation. In addition, endothelial function was compared with that in a group of 16 patients treated by thrombolysis in a different time period. The mean change in the diameters of segments distal to the culprit lesion or the treated lesion were evaluated by quantitative coronary angiography.


RESULTS
Baseline characteristics were similar in the two groups, except that patients in the primary angioplasty group were treated with clopidogrel and there were differences in residual stenosis in the infarct-related artery (3% in the primary angioplasty group compared with 62% in the thrombolysis group). At the maximum acetylcholine concentration, the degree of vasoconstriction was less in the primary angioplasty group than in the thrombolysis group (-4+/-5% vs. -20+/-21%; P=.018).


CONCLUSIONS
Early endothelium-dependent vasoconstriction in the infarct-related artery was lower in acute myocardial infarction patients treated by primary angioplasty and bare-metal stent implantation than in those treated by thrombolysis.
González-Costello
José
J
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. jgcostello@hotmail.com
Iràculis
Emili
E
Gómez-Hospital
Joan A
JA
Maristany
Jaume
J
Jara
Francesc
F
Espulgas
Enric
E
Cequier
Angel
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003331:Coronary Vessels / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014661:Vasoconstriction