The effect of early percutaneous coronary intervention following thrombolysis on myocardial perfusion and ventricular remodeling in patients with acute myocardial infarction

doi:10.3969/j.issn.1002-1949.2014.09.014

Abstract：Objective To evaluate the influence on myocardial perfusion ventricular remodeling using primary percutaneous coronary intervention ( PCI ) and early PCI following thrombolysis via transradial approach therapy in older patients with acute myocardial infarction ( AMI) by the 99m Tc-MIBI SPECT myocardial perfusion imaging combined with echocardiogram .Methods A total of 172 patients ( age >60 years ) with primary anterior AMI were enrolled in this study .There were 116 patients in primary PCI group ( P-PCI) and 56 patients in early PCI following thrombolysis group ( E-PCI) .At 1 week and 28 weeks after AMI , the left ventricular myocardium weight index ( LVMWI) was measured by echocardiogram , while the parameters of ischemic extent score ( ES ) and severity score ( SS) were measured by rest and nitroglycerin interventional 99m Tc-MIBI SPECT to identify the viablemyocardium size 1 week after PCI.Major adverse cardiac events (MACE) such as post-AMI angina, recurrence MI or mortality were recorded during 28 weeks follow -up.Results ①There were no significant differences between the two groups in clinical characteristics .②The coronary angiography showed that the TIMI -3 grade of infarction -related artery ( IRA) in E -PCI group was markedly higher than that in P -PCI group (30.36% vs 8.62%, χ2 =11.16, P<0.01).The TIMI-3 grade rate of IRA post-PCI in E-PCI group was higher than that in P -PCI group (98.21% vs 88.76%,χ2 =4.38, P<0.05).③At 28 weeks post -AMI, the values of ES and SS in E -PCI group were markedly decreased compared with those in P -PCI group after nitroglycerin interventional 99m Tc-MIBI SPECT[(0.31 ±0.07)vs (0.52 ±0.10),(118 ±26)vs (153 ±23), P<0.05, respectively].④At 28 weeks, LVMWI in E -PCI group was significantly decreased as compared with P -PCI group [(105 ±46)vs (128 ±33), P<0.05].⑤There were no significant differences between the E -PCI group and P -PCI group in complication and MACE rates .Conclusion The early PCI following thrombolysis via transradial approach therapy might significantly increase the viable myocardium size and inhibit left ventricular remodeling by the persistent repatency of IRA , which is superiority to the primary PCI therapy .