Intracoronary stenting and left-ventricular myocardial function after primary PTCA in acute myocardial infarction

In acute myocardial infarction intracoronary stenting is superior to PTCA r egarding interventional success and occurrence of cardiac events. It is, ho wever, uncertain whether my ocardial function also improves with stenting. We, therefore, assessed angiographic parameters of myocardial function in p atients with acute myocardial infarction who were treated with primary PTCA and received additional stenting in case of an unsatisfactory angiographic result (provisional stenting). Nineteen patients with acute myocardial infarction, in whom a "stent-like" angiographic result was achieved by PTCA alone, were compared with an equal number of patients receiving provisional stenting. The groups were exactly matched with respect to severity of coronary heart disease, segment of cor onary occlusion, Killip class, and TIMI flow after intervention. We only in cluded patients without inhospital cardiac events, in whom repeat angiograp hy after ten days revealed a patent target vessel. There were no difference s between both groups regarding age, gender, enzymatic infarction size, dur ation of ischemia (less than or equal to 12 h), and cardiac risk factors. M yocardial function was assessed by ventriculography and was analyzed quanti tatively by the centerline method. The group treated by intracoronary stenting showed a significantly improved ejection fraction (60.3 +/- 2.1% vs. 52.6 +/- 2.9%). All parameters of reg ional wall motion also indicated significantly less functional disturbance in the stented group compared to PTCA alone (circumferential extend of hypo kinesia: 7.4 +/- 2.4 % vs. 16.1 +/- 3.4 % chords, maximum hypokinesia in th e central infarct region: -0.98 +/- 0.20 vs. -1.52 +/- 0.15 SD, severity of regional hypokinesia: 7.3 +/- 2.6 vs. 21.9 +/- 5.4 area). In summary, thes e results in patients undergoing primary PTCA in acute myocardial infarctio n indicate that intracoronary stenting is superior to PTCA alone with respe ct to myocardial recovery, even if an angiographically "stent-like" result can be achieved. Probably, stenting results in a more efficient reperfusion .