Increasingly Well-Preserved Left Ventricular Function in Hospital Survivors With Acute Myocardial Infarction Effect of Early and Complete Reperfusion Strategy on Left Ventricular Remodeling

Abstract

rogress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced mortality in the acute phase, which is when most deaths associated with AMI occur. [1][2][3][4] Reperfusion therapy is classified as either thrombolytic therapy, which is easy to perform and promptly achieves Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow (TIMI-3 flow), or percutaneous coronary intervention (PCI), which has a higher reperfusion rate. The advantages and disadvantages of the 2 therapies have long been controversial; [5][6][7] however, the accumulation of data from recent large-scale randomized controlled trials has provided evidence-based information on reperfusion therapy, [8][9][10][11] leading to increasing awareness of the importance of starting reperfusion therapy as early as possible after the onset of AMI, regardless of the modality, in order to achieve earlier and complete revascularization of infarctrelated arteries (IRAs) and to maintain revascularization.As a result, a new treatment strategy needs to be developed.Against this backdrop, we have performed combination therapy (FAST therapy: Fibrinolytic And Subsequent Transluminal angioplasty 12 ) since 1997. It involves administering a thrombolytic agent as early as possible after the diagnosis of AMI, followed by PCI if TIMI-3 flow is not achieved. We have shown recently in the FAST trials that the shorter door-to-TIMI-3 time (time interval from arrival at the emergency room until the patient achieves TIMI-3 flow), the more left ventricular (LV) remodeling is suppressed, which indicates that achieving and maintaining TIMI-3 flow early after AMI onset is crucial for myocardial protection. 13 The purpose of this study was to investigate how LV remodeling, a prognostic factor in hospital survivors with myocardial infarction (MI), has changed with the changes in treatment, especially advancements in coronary reperfusion therapy, during the 14-year period from 1989 to 2002.We re-examined the relationship between the factors affecting reperfusion, including the door-to-TIMI-3 time, and LV remodeling and discuss the significance of reperfusion therapy for AMI. Methods SubjectsFor this study, we selected 813 patients with a first diag- Background Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI. Methods and ResultsThe study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55±14, 58±13, 59±13, 61±13%, p<0.001; 98±30, 94±27, 90±31,...

Correlation of Serial Cardiac Magnetic Resonance Imaging Parameters With Early Resolution of ST-Segment Elevation After Primary Percutaneous Coronary Intervention

“…6,18 Hypoenhancement within the hyperenhanced areas on delayed imaging is considered to be related to microvascular obstruction caused by endothelial damage, occluding thrombi and the influx of inflammatory cells. 19 Microvascular dysfunction is known to be associated with greater myocardial damage and contributes to LV remodeling, together with infarct size.…”

Erythropoietin in Patients With Acute Coronary Syndrome and Its Cardioprotective Action After Percutaneous Coronary Intervention

“…1,2 Compared with thrombolytic therapy, early primary percutaneous coronary intervention (PCI) gives the higher rate of recanalization, and the higher rate contributes to a decrease prevalence of cardiac events, and improve LV contractility and survival prognosis. [3][4][5] In daily clinical practice, however, we have often found such AMI patients who develop remarkable LV remodeling in the chronic phase in spite of recanalization by PCI in the early phase after the attack. Erythropoietin (EPO), which controls erythropoiesis, is a glycoprotein hormone with molecular weight of 34,000 consisting of 165 amino acid residues, and is secreted from the renal interstitium in response to hypoxic stimuli.…”

Inhibitory Effect of Valsartan Against Progression of Left Ventricular Dysfunction After Myocardial Infarction

“…19 The reperfusion phenomenon has also been reported to be a strong predictor of LV remodeling after AMI. 2,20 However, the most reliable predictor of remodeling after MI reported from previous experimental and clinical studies is the infarct size. [21][22][23] Most previous studies were performed retrospectively and not all patients received coronary reperfusion therapy along with ACEI or ARB administration.…”

“…2 However, AMI patients successfully treated by coronary interventions within a few hours of the onset sometimes develop severe myocardial dysfunction in the chronic stage as a result of myocardial remodeling. Left ventricular (LV) remodeling after AMI limits the long-term prognosis of these patients and remains an important predictor of mortality.…”