The effect of medical therapy on ventricular remodeling after early reperfusion in patients with acute anterior myocardial infarction

ZHANG Xiao-xia; MI Shu-hua; CHI Zhe; TIAN Lei; WANG Yang; WANG Xi-zhi; DAI Wen-long

doi:10.3760/cma.j.issn.1673-4777.2012.06.008

Abstract：Objective To investigate the use of ACE inhibitors/angiotensin type 1 receptor blokers ( ACEI/ARB) and β receptor blockers(β-B) in patients with acute anterior myocardial infarction(MI) after infarct related artery(IRA) were opened by percutaneous coronary intervention(PCI).Methods Totally 232 consecutive patients with acute anterior MI who admitted to our hospital from 2009.1 to 2012.12 were enrolled.These patients fulfilled the following criterion:IRA were opened by immediate PCI and there were at least two leads of V1 ～ V6 having Q waves.In hospital clinical data [ including age,gender,combined disease,heart rate,blood pressure,number of Q wave,left ventricular end diastolic diameter(LVEDD),left ventricular eject fraction,number of abnormal motione regional walls,in hospital therapy,etc.] were collected and the out-patient electronic medical records were reviewed.The status of the use of ACEI/ARB and β-B were observed.The effect on left ventricular remodeling was analyzed retrospectively.Results The follow-up were completed in 202 (87.1％ ) patients and the average followup time was 6 months.At the end of follow up,the proportion of ACEI/ARB use was significantly lower in patients with enlarged LVEDD compared to patients with normal LVEDD(79.2％ vs.92.6％,P ＜ 0.05 ),and the dose was also signiftcantly lower( 1.3 ± 0.9 vs.1.7 ± 0.9,P ＜ 0.01 ).The use of β-B in patients with enlarged LVEDD were significantly lower than that in patients with normal LVEDD on admission,discharge and at the end of follow up.Logistic regression analysis showed that low dose of ACEI/ARB was an independent risk factor of left ventricular remodeling.Conclusion Patients with obvious Q waves are more likely to develop a enlarged left ventricular despite immediate PCI.Insufficient medical therapy fails to prevent ventricular remodeling.