INFLUENCE OF REPERFUSION INDUCED BY THROMBOLYTIC TREATMENT ON NATURAL-HISTORY OF LEFT-VENTRICULAR REGIONAL WALL MOTION ABNORMALITY IN ACUTEMYOCARDIAL-INFARCTION

Although several studies have investigated left ventricular (LV) funct ion after reperfusion interventions, it is still unclear whether benef its result from successful therapy or whether such benefits only refle ct the natural history of a subgroup of patients with acute myocardial infarction (AMI). This study evaluates the unique effect of thromboly tic therapy on the natural history of regional LV wall motion dysfunct ion. One hundred seventy-six patients with AMI were studied: 82 patien ts (group A) underwent conventional treatment and 94 (group B) thrombo lytic therapy. LV regional improvement, evaluated by changes in echo s core between admission and predischarge examination, was present more frequently in group B (28%) than in group A (17%). Furthermore, improv ed patients in group B had higher admission echo scores (7.5 +/- 3.5 v s 6.3 +/- 3.1), a prevalence of anterior AMI (68 vs 30.1%) and a highe r rate of coronary patency (92 vs 58% in patients who had no improveme nt). In group A patients the rate of coronary patency was similar in t hose who did (46.1%) and did not have (36.1%) improvement. Observation s at 12 to 18 months showed similar data in group A patients and in gr oup B patients without improvement, whereas a marginal additional impr ovement was observed in group B patients who had in-hospital improveme nt. These observations demonstrate that LV function recovery is more f requent and marked in treated than in untreated patients. Follow-up re sults suggest a prolonged beneficial effect of thrombolytic treatment on LV function. The highest rate of coronary patency in improved group B patients underline the role of reperfusion on natural history of LV dysfunction after AMI.