CLINICAL STUDIES
Time dependence of left ventricular recovery after delayed recanalization of an occluded infarct-related coronary artery: findings of a pilot study
Matthias E. Pfusterer, MD, FACCa,
Peter Buser, MD, FACCa,
Stefan Osswald, MD, FACCa,
Philipp Weiss, MDa,
Jens Bremerich, MDb and
Felix Burkart, MDa,*
a Division of Cardiology, Department of Internal Medicine, University Hospital, Basel, Switzerland
b Division of Cardiology, Department of Radiology, University Hospital, Basel, Switzerland
Manuscript received November 6, 1997;
revised manuscript received March 4, 1998,
accepted March 16, 1998.
Address for correspondence: Dr. Matthias Pfisterer, Division of Cardiology, Department of Internal Medicine, University Hospital, CH-4031 Basel, Switzerland
pfisterer{at}email.ch
Objectives. We sought to test the hypothesis that late recanalization of infarct-related coronary arteries (IRAs) improves long-term left ventricular (LV) function.
Background. Reperfusion within 24 h of an acute myocardial infarction (MI) has been shown to improve myocardial healing and to reduce infarct expansion. Uncontrolled data suggest that there may be a time window of several weeks for such an effect.
Methods. Sixteen asymptomatic patients 10 ± 4 days after a first Q wave anterior wall MI with persistent left anterior descending coronary artery occlusion and infarct-zone akinesia were randomized to immediate (2 weeks) or delayed (3 months) angioplasty. Repeat catheterization and cardiac magnetic resonance imaging (MRI) were performed after 3 and 12 months.
Results. Angiography 3 months after MI revealed that LV ejection fraction (LVEF) had increased ([mean ± SD] 54.4 ± 4.3% vs. 63.9 ± 7.4%, p < 0.01) as a result of improved regional function (p < 0.01) and LV end-systolic volume had decreased (p < 0.002), whereas LV end-diastolic volume remained unchanged. With delayed angioplasty, LVEF, infarct zone wall motion and LV volumes did not improve. Cardiac MRI at baseline and at 3 and 12 months confirmed these findings and extended them up to 1 year, indicating that delayed angioplasty could no longer improve LV function because of marked LV dilation (p < 0.01). Immediate angioplasty had a high success rate, but restenosis (50%) was accompanied by new severe angina as a clinical indicator of salvaged myocardium, which did not occur after delayed angioplasty.
Conclusions. This pilot study in selected patients supports the hypothesis that myocardial viability persists ("hibernation") for 2 to 3 weeks but not for 3 months after MI, during which time it may be worthwhile to restore blood flow to a large myocardial territory, even in asymptomatic patients, to improve long-term LV function.
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Abbreviations and Acronyms
| | CT | = computed tomography | | IRA | = infarct-related coronary artery | | LAD | = left anterior descending coronary artery | | LV | = left ventricular | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | MRI | = magnetic resonance imaging | | TIMI | = Thrombolysis in Myocardial Infarction |
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