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Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the
Ahmet Celik1, Nihat Kalay2, Hasan Korkmaz1
1Department of Cardiology, Elazıg Education and Research Hospital, Elazig, Turkey.
Insights
Percutaneous coronary intervention (PCI) for total left anterior descending artery occlusion in subacute myocardial infarction increases left ventricular remodeling. However, PCI for subtotal occlusion may prevent this remodeling.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Percutaneous coronary intervention (PCI) offers no clinical benefit for total coronary artery occlusion.
- Left ventricular (LV) remodeling is a critical factor in post-myocardial infarction outcomes.
- Evaluating LV remodeling after PCI in specific occlusion types is crucial for treatment strategies.
Purpose of the Study:
- To assess left ventricular (LV) remodeling after PCI in stable patients with total or subtotal occlusion of the infarct-related left anterior descending artery.
- To compare LV remodeling between medical management, PCI for total occlusion, and PCI for subtotal occlusion.
Main Methods:
- Sixty stable patients with subacute anterior myocardial infarction and total/subtotal left anterior descending artery occlusion were divided into three groups: total-medical, total-PCI, and subtotal-PCI (20 patients each).
- Echocardiographic parameters, including LV diameters, volumes, and ejection fraction, were measured at admission and one month post-intervention.
- Scintigraphy was used to assess necrotic segment number across groups.
Main Results:
- No significant difference in necrotic segment number was observed between the three groups.
- The total-PCI group showed significant increases in LV diastolic diameter, LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) at one month.
- The subtotal-PCI group exhibited no significant changes in echocardiographic parameters, suggesting prevention of LV remodeling.
Conclusions:
- PCI for total left anterior descending artery occlusion in the subacute phase of anterior myocardial infarction leads to increased LV remodeling.
- PCI for subtotal occlusion in the same clinical context may effectively prevent LV remodeling.
- These findings highlight the importance of differentiating occlusion severity when considering PCI in acute myocardial infarction patients.
Background:
Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy.
Methods:
Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients' left ventricular diameters, volumes and ejection fractions measured at admission and after a month.
Results:
The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups.
Conclusions:
In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.