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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Evolution of Left Ventricular Ejection Fraction and its Relationship to Infarct Size After Acute Myocardial Infarction

Gjin Ndrepepa, MD^_*,_*, Julinda Mehilli, MD^_*, Stefan Martinoff, MD^_*, Markus Schwaiger, MD, Albert Schömig, MD^_*, and Adnan Kastrati, MD^_*

^_* Deutsches Herzzentrum, Technische Universität, Munich, Germany
Medizinische Klinik rechts der Isa, Technische Universität, Munich, Germany
Klinik und Poliklinik für Nuklearmedizin rechts der Isar, Technische Universität, Munich, Germany.

Manuscript received January 12, 2007; revised manuscript received January 31, 2007, accepted March 6, 2007.

^_* Reprint requests and correspondence: Dr. Gjin Ndrepepa, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. (Email: ndrepepa{at}dhm.mhn.de).

Objectives: The aim of this study was to investigate the evolution of left ventricular (LV) function and infarct size in patients with acute myocardial infarction (MI) treated with primary coronary stenting.

Background: Little evidence exists on the relationship between LV function and evolution of infarct size after MI.

Methods: This study included 626 patients with first acute MI who underwent 2 angiographic and 3 scintigraphic examinations within 6 months after the acute event. Angiographic left ventricular ejection fraction (LVEF) at baseline and at 6-month angiography, and perfusion defects before intervention and at 7- to 14-day and 6-month scintigraphy after intervention were measured. An analysis of 3-year follow-up was performed.

Results: Scintigraphic perfusion defect (median [25th, 75th percentiles]) was 24.6% [14.0%, 41.0%] of LV before intervention; it was reduced to 11.0% [5.0%, 24.0%] of LV at 7 to 14 days and further to 8.0% [2.0%, 19.0%] of LV at 6 months (p < 0.001). The LVEF was 51.6 ± 12.0% before intervention and increased to 57.4 ± 12.8% at 6 months (p > 0.001). Independent predictors of LVEF change were baseline LVEF (p < 0.001), initial perfusion defect (p < 0.001), early reduction in perfusion defect (p < 0.001), late reduction in perfusion defect (p < 0.001), peak creatine kinase-MB (p < 0.001), and smoking (p = 0.05). Three-year mortality was 1.2% in patients with improved LF function versus 5.6% in patients with worsened LV function (relative risk 0.29, 95% confidence interval 0.09 to 0.90; p = 0.03).

Conclusion: Patients with acute MI show an improvement in LV function and a reduction in infarct size within 6 months after coronary reperfusion. This improvement is associated with better long-term survival.

Abbreviations and Acronyms   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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