Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease.
OBJECTIVE
The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multivessel disease (MVD).


METHODS
A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140mmHg) were assigned to the first group (n=58); with normal ASBP (<140mmHg), to the second group (n=46); with increased myocardial mass index (MMI) (>100g/m(2)), to the third group (n=70); and with normal MMI (<100g/m(2)), to the fourth group (n=34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months.


RESULTS
There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%±8.25% vs. 46.8%±7.13%, P=0.018).


CONCLUSIONS
Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: edvardas.vaicekavicius@lsmuni.lt.
Edvardas
E
Vaicekavičius
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Donatas
D
Vasiliauskas
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Ramūnas
R
Navickas
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Irena
I
Milvidaitė
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Ramūnas
R
Unikas
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Jonė
J
Venclovienė
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Raimondas
R
Kubilius
D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000473:pathology; D009929:Organ Size; D062645:Percutaneous Coronary Intervention; D020127:Recovery of Function; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology*; D016277:Ventricular Function, Left
Left ventricular function; Multivessel coronary artery disease; Postreperfusion left ventricle recovery; Primary percutaneous coronary intervention