Factors affecting left ventricular function in patients with acute myocardial infarction and ST segment elevation after successful primary percutaneous coronary intervention (the 1-year follow-up data)
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Abstract
The aim – to determine influence of angiographic and electrocardiographic signs that appear during primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction and ST segment elevation (ST elevation myocardial infarction – STEMI) upon left ventricular function at 1-year follow-up. In addition, we evaluated the long-term results of intervention including aspiration thrombectomy.
Material and methods. 460 consecutive patients with STEMI underwent emergent pPCI. Indicators of left ventricular function, such as ejection fraction and regional wall motion were examined at 1-year follow up. The patients were divided into three groups: PCI performed during first two hours after infarction development (group 1); 2–6 hours (group 2) and 6 hours and more (group 3).
Results. One-year follow up revealed best condition of left ventricular hemodynamics in patients with early pPCI as compared to patients with late pPCI: the end-systolic volume and the end-diastolic volume were significantly lower in group 1 compared to group 3 (P<0.05). Left ventricular ejection fraction was significantly higher in group 1 than in group 3 (P<0.05). Number of dyskinesias was significantly higher in group 3 than in group 1 (P<0.05). At the same time, the degree of myocardial blood flow was much higher in group 1 compared with group 3 (P<0.0001). Ejection fraction in cases of myocardial perfusion recovery to the level of myocardial blood grade (MBG) 3, as compared with MBG 1 or 2, was significantly higher (P<0.01).
Conclusions. The study showed that preservation of left ventricular hemodynamics in patients with acute myocardial infarction with ST segment elevation undergoing pPCI depends not only on the recovery of epicardial perfusion, but also on the recovery of myocardial perfusion. Blood clots aspiration during pPCI plays an important role in the treatment of patients with STEMI.
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