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Effect of successful angioplasty following thrombolysis on infarct size and left ventricular function
1Cardiovascular Division, Osaka Police Hospital, Japan.
Insights
Immediate angioplasty after thrombolysis for acute myocardial infarction reduced infarct size compared to no reperfusion. However, rescue angioplasty showed no benefit over failed thrombolysis for infarct size or heart function.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) management often involves reperfusion strategies.
- The role of angioplasty following thrombolysis in AMI requires further evaluation regarding its impact on infarct size and left ventricular function.
Purpose of the Study:
- To evaluate the effect of successful immediate and rescue angioplasty on infarct size and left ventricular function in patients with primary anterior AMI.
Main Methods:
- Retrospective analysis of 104 patients with primary anterior AMI who achieved reperfusion.
- Patients were categorized into thrombolysis, immediate angioplasty, rescue angioplasty, and non-reperfused groups.
- Infarct size assessed by T1-201 SPECT; left ventricular function and end-diastolic volume measured.
Main Results:
- Immediate angioplasty resulted in infarct sizes similar to thrombolysis alone but significantly smaller than the non-reperfused group.
- No significant differences in left ventricular function were observed between immediate angioplasty and thrombolysis groups.
- Successful rescue angioplasty did not improve infarct size or left ventricular function compared to failed thrombolysis, though end-diastolic volume was smaller.
Conclusions:
- Immediate angioplasty following successful thrombolysis in AMI may help reduce infarct size.
- Rescue angioplasty does not appear to offer significant benefits for infarct size or left ventricular function when thrombolysis fails.
Abstract:
The role of the angioplasty following thrombolysis in acute myocardial infarction has been discussed in several studies, however the effect of successful angioplasty on infarct size and left ventricular function has not been properly evaluated. Successful reperfusion was achieved in 79 out of 104 patients with primary anterior acute myocardial infarction. These patients were classified as follows, according to the type of intervention during the acute phase: 50 patients in which thrombolysis was successful (the thrombolysis group); 12 patients who underwent successful immediate angioplasty following successful thrombolysis (the immediate angioplasty group); and 17 patients in which rescue angioplasty was successful (the rescue angioplasty group). The 25 patients whose infarct-related vessels were not reperfused after intervention were classified as the non-reperfused group. Infarct size, evaluated as defect volume by T1-201 SPECT, 1 month after the onset, was 840 +/- 154 units (mean +/- S.D.) in the immediate angioplasty group and was similar to that in the thrombolysis group (948 +/- 88 units), but significantly smaller than in the non-reperfused group (1759 +/- 108 units). There were no significant differences in left ventricular function in the immediate angioplasty group and the thrombolysis group. Successful rescue angioplasty did not have any beneficial effect on left ventricular functions or infarct size, when compared with the failed thrombolytic group (1105 +/- 169 units vs. 1617 +/- 169 units). End-diastolic volume (52 +/- 3 ml/m2) in the successful rescue angioplasty group, however, was significantly smaller than in the failed thrombolysis group (67 +/- 3 ml/m2).(ABSTRACT TRUNCATED AT 250 WORDS)