Percutaneous coronary intervention for myocardial infarction with left ventricular dysfunction.
Patients who have had a myocardial infarction (MI) are at high risk for developing left ventricular dysfunction (LVD), which predisposes them to heart failure and is associated with an increased mortality risk. Early coronary revascularization, either with percutaneous coronary intervention or coronary artery bypass graft surgery, plays an important role in the preservation and restoration of left ventricular function after MI. This article discusses the effects of primary and nonemergent percutaneous coronary revascularization procedures on survival, left ventricular function, and the occurrence of complications, such as recurrent MI and stroke, compared with the effects of thrombolytic therapy. In addition, this article describes rescue revascularization procedures for patients who failed thrombolysis and those presenting relatively late or with negative electrocardiographic findings. Advanced interventional techniques, such as percutaneous ventricular assist devices and bioabsorbable stents, are very promising and may potentially help improve the outcomes of post-MI patients with LVD; however, the use of these techniques requires further validation.
Flaherty
James D
JD
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. j-flaherty2@md.northwestern.edu
Davidson
Charles J
CJ
Faxon
David P
DP
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy*