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,...