Prevention of left ventricular remodeling by percutaneous transluminal coronary angioplasty performed 24 hours after the onset of acute myocardial infarction

It remains controversial whether percutaneous transluminal coronary angiopl asty (PTCA) performed 24 hours after the onset of acute myocardial infarcti on (AMI) in coronary arteries with 99% stenosis is useful in preserving lef t ventricular function. We investigated the effectiveness of PTCA in preven ting left ventricular remodeling when it was performed 24 hours after the o nset of AMI in infarct-related coronary arteries (IRCAs) having 99% stenosi s and thrombolysis in myocardial infarction (TIMI) grade 3 flow. The subjec ts were 19 patients with AMI (anterior wall, 9 patients; inferior wall, 7 p atients; and non-Q, 3 patients) who, within 24 hours of the onset of AMI, u nderwent coronary angiography and left ventriculography during the acute an d/or chronic phases. The patients were divided into a PTCA group, comprised of patients in whom PTCA was successfully performed 24 hours after the ons et of AMI (n = 10), and a non-PTCA group (n = 9). The non-PCTA group includ ed patients who were successfully reperfused by thrombolysis and did not in clude patients who had spontaneous reperfusion or reperfusion after PTCA. I n the non-PTCA group, the left ventricular end-diastolic volume (mean +/- S D) was significantly increased in the chronic phase (86 +/- 23 mL/m(2)) as compared with the acute phase (67 +/- 13 mL/m(2)), whereas in the PTCA grou p no significant difference was observed between end-diastolic volumes in t he acute and chronic phases (67 +/- 26 and 68 +/- 13 mL/m(2), respectively) . Left ventricular remodeling is prevented by PTCA when it is performed 24 hours after the onset of AMI in IRCAs with 99% stenosis and TIMI grade 3 fl ow.