BENEFICIAL-EFFECTS OF MECHANICAL REPERFUSION THERAPY ON LEFT-VENTRICULAR REMODELING AND LATE OUTCOME FOLLOWING MYOCARDIAL-INFARCTION

The long-term relative benefits of thrombolysis and mechanical reperfu sion therapy following acute myocardial infarction (AMI) have not been established. The purpose of this study was to compare left ventricula r function, left ventricular remodeling and late outcome after AMI. fo r different reperfusion therapies. Thirty consecutive patients sufferi ng their first anterior wall myocardial infarction with coronary steno ses limited to the left anterior descending coronary artery were studi ed. They included IO patients who underwent intracoronary thrombolysis (ICT), 10 who underwent PTCA and 10 who underwent noninterventional m edical treatment. All patients underwent coronary angiography (CAG) du ring the acute phase of AMI and also during the follow-up period, and left ventriculography during the follow-up period and clinical follow- up was performed (mean clinical follow-up period: 53 +/- 31 months). N o significant difference in global ejection fraction was noted among t he groups, although the end-diastolic Volume index (EDVI) in the PTCA group (79.4 +/- 17.5 ml/m(2)) was significantly smaller than in the no ninterventional (106.1 +/- 25.1 ml/m(2)) and ICT (107.9 +/- 28.3 ml/m( 2)) groups (p < 0.05). The regional wall motion index (RWMI) for the a nterior region in the PTCA group (- 2.7 +/- 0.8) was greater (p < 0.05 ) than in the noninterventional (- 3.4 +/- 0.6) and ICT (- 3.3 +/- 0.6 ) groups. A significant linear correlation was found between EDVI and % diameter stenosis and also between RWMI and % diameter stenosis foll owing reperfusion (p=0.01). There was no difference in the incidence o f cardiac death, nonfatal reinfarction, bypass surgery or congestive h eart failure among the groups. Disturbed left ventricular regional wal l motion and remodeling benefit most from angioplasty because of promp t restoration of adequate blood flow. However, there was no difference in late outcomes following AMI among the three groups.