ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

摘要

Introduction Spontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes. Aim To investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling. Material and methods Of 155 STEMI patients with patent IRA, 19 (12.3%) patients with TIMI-2 (T2subRes/sub) and 85 (54.8%) with TIMI-3 (T3subRes/sub) had further STE resolution following PCI, 20 (12.9%) with TIMI-3 did not require PCI (T3subnoPCI/sub) and 31 (20.0%) with TIMI-2/3 had reSTE of ≥ 1 mm following PCI as compared with pre-PCI recordings (T23subreSTE/sub). LV ejection fraction (LVEF, %) and LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI, ml/m2) were measured by echocardiography 2 days and 6 months following PCI. Results In 6-month observation the improvement of LVEF in T3subRes/sub (by 3.9 ±5.1%) and in T3subnoPCI/sub (by 5.7 ±6.1%) patients was higher as compared with T23subreSTE/sub (0.2 ±7.0%, p 0.05 versus both). LVEDVI increased in T23subreSTE/sub patients by 6.6 ±12.6 ml/m2, but decreased in T3subRes/sub by 3.8 ±9.7 ml/m2 and in T3subnoPCI/sub by 2.4 ±6.2 ml/m2 (for both p 0.05 vs. T23subreSTE/sub). LVESVI increased in T23subreSTE/sub patients (by 3.8 ±10.8 ml/m2), did not change in T2subRes/sub (by 0.1 ±9.0 ml/m2), but decreased in T3subRes/sub (by 4.2 ±7.2 ml/m2, p 0.05 vs. T23subreSTE/sub) and in T3subnoPCI/sub patients (by 4.7 ±7.7 ml/m2, p 0.05 vs. T23subreSTE/sub). ReSTE was an independent predictor of LVEF, LVEDVI and LVESVI changes (p 0.001 for all). Conclusions ReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.