Left ventricular remodeling and function after primary and delayed PCI in patients with recent myocardial infarction

Background

It has been well established that restoration of patency of an infract-related artery by percutaneous intervention as early as possible in patients with recent myocardial infarction may preserve left ventricular global function and also prevent LVEDV progressive increase and remodeling.

Aim

To evaluate and compare the effect of primary and delayed PCI in patients with recent myocardial infarction (MI).

Methods

Forty patients were included in the study with first anterior MI; they were divided into group A who had the chance of undergoing primary PCI within less than 12 hours of start of chest pain with mean 5.4 hours and a door to balloon time of 1.6 hours, and group B who due to out of hand circumstances neither received thrombolytic therapy nor arrived at hospital within 12 hours, but were scheduled as routine PCI with mean 20.7 days. The left ventricular function and dimensions were assessed by serial echocardiographic readings measuring LVEDV, LVESV, EF and RWMI at 24 hours of admission and after 3 months and 6 months. Results were expressed as mean ± standard deviation and P < 0.005 was considered significant.

Results

First echo results at baseline showed no significant difference of LVEDV, RWMI and EF in both group A and group B, that indifference was also remarkerable at echo done at 3 months with P = 0.6, while at 6 months reading the LVEDV in group A showed a significant decrease (115 ± 32.14 vs 138 ± 32.96, P = 0.048). Ejection fraction difference between two groups were not significant at baseline echo, but improved significantly at 3 and 6 months (58.5 ± 4.5 vs 55.2 ± 6.4, P = 0.046 at 3 months and 59.5 ± 6.81 vs 51.88 ± 10.7, P = 0.008 at 6 months, respectively). RWMI results started to improve significantly from 3 months to 6 months in group A versus group B (1.27 ± 0.13 vs 1.38 ± 0.18, P = 0.032 at 3 months) but at 6 months there was no further improvement with P = 0.6.

Conclusion

Although the recent evolvement and the theory of opening of IRA whatever the timing, primary PCI has superiority in preventing LV remodeling and preserving global LV function.