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CLINICAL STUDY

Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction

Imad Sheiban, MD^*, Gabriele Fragasso, MD, Giuseppe M. C. Rosano, MD, Aniruddha Dharmadhikari, MD, Vaios Tzifos, MD, Paolo Pagnotta, MD, Sergio L. Chierchia, MD, FESC, FACC and Gianpaolo Trevi, MD^*

^* Department of Internal Medicine, Division of Cardiology, University of Torino, Torino, Italy
Department of Cardiology, Istituto Scientifico/Università San Raffaele, Milano, Italy
Cardiovascular Research Unit, San Raffaele–Roma, Tosinvest Sanita’, Roma, Italy

Manuscript received August 7, 2000; revised manuscript received April 19, 2001, accepted April 27, 2001.

Reprint requests and correspondence: Dr. Imad Sheiban, Department of Internal Medicine, Division of Cardiology, Interventional Cardiology Laboratory, University of Torino, Ospedale San Giovanni Battista "Molinette," I-10126 Torino, Italy
isheiban{at}yahoo.com

OBJECTIVES

We sought to evaluate the importance of time in relation to treatment, time course and determinants of recovery of left ventricular (LV) function in patients with acute myocardial infarction (AMI) undergoing primary percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND

Myocardial salvage has been shown to be dependent on the time elapsed from the onset of AMI to reperfusion.

METHODS

Left ventricular function was evaluated at hospital admission, after angioplasty, at 24 h and 6 months by both echocardiography and angiography and at 1, 7, 30, 90 and 180 days by echocardiography in 101 consecutive patients.

RESULTS

Patients were allocated to three groups according to interval between symptom onset and angioplasty: <2 h (group A), 2 to 4 h (group B) and >4 h (group C). Patients in groups A and B showed a progressive improvement of LV function between day 7 and day 90, which became statistically significant at day 30 (p < 0.01). No LV function changes were noted in group C patients. Thrombolysis In Myocardial Infarction (TIMI) flow grade <3 at 24 h was not associated with any significant change in LV volume and function during the six-month follow-up period. Restenosis, when associated with TIMI flow grade 3 in the infarct-related vessel, did not influence LV function. Flow grade <3 of the infarct-related artery was not associated with any improvement of cardiac events independently from the time to treatment at the initial procedure.

CONCLUSIONS

Patients undergoing primary PTCA for AMI have a good recovery of LV function if TIMI flow grade 3 is restored within 4 h. Coronary angioplasty limits further remodeling of the LV in patients treated after 4 h.

Abbreviations and Acronyms   AMI = acute myocardial infarction   ANOVA = analysis of variance   CK = creatine kinase   IRA = infarct-related artery   LV = left ventricular   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction   WMSI = wall motion score index

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