Circulation, Vol 88, 2565-2574, Copyright © 1993 by American Heart Association
A Hirayama, T Adachi, S Asada, M Mishima, S Nanto, H Kusuoka, K Yamamoto, Y Matsumura, M Hori and M Inoue
BACKGROUND. While previous clinical studies have shown a possible
beneficial effect of the reperfusion performed at a relatively late phase
of acute myocardial infarction ("late reperfusion") in preventing left
ventricular enlargement, the mechanism has not been clarified. METHODS AND
RESULTS. Of 89 patients with an initial anterior myocardial infarction,
reperfusion was successful in 69. These 69 were divided into three groups
according to the time required to achieve reperfusion after the onset of
symptoms: early-reperfused (< 3 hours from the onset to reperfusion; n =
22), intermediate-reperfused (3 to 6 hours from the onset to reperfusion; n
= 28), and late-reperfused (> 6 hours from the onset to reperfusion; n =
19). The 20 patients whose infarct-related artery were occluded in the
acute phase as well as 1 month later was classified as nonreperfused.
Infarct size, evaluated as defect volume by 201Tl single-photon emission
computed tomography 1 month after the onset, was 1593 +/- 652 units (mean
+/- SD) in the late-reperfused group, significantly larger (P < .05)
than that of the intermediate- reperfused (1066 +/- 546 U) or the
early-reperfused groups (372 +/- 453 U) but not different from that of the
nonreperfused group (1736 +/- 562 U). Wall motion abnormality index as well
as global ejection fraction evaluated by left ventriculography 1 month
after the onset showed that late reperfusion did not preserve the left
ventricular wall motion and function. These results indicate that the
earlier reperfusion decreased the size of the infarction and preserved left
ventricular function, whereas late reperfusion (> 6 hours after onset)
did not limit infarct size or preserve left ventricular function. In
contrast, the end- diastolic volume index did not differ significantly
among the early- reperfused (50 +/- 15 mL/m2), intermediate-reperfused (54
+/- 14 mL/m2), and late-reperfused (53 +/- 19 mL/m2) groups; those were
significantly smaller than that of the nonreperfused group (68 +/- 12
mL/m2; P < .05). Left ventriculographic data obtained in both the acute
and chronic phase in 39 patients showed that left ventricular volumes
increased significantly during the course of myocardial infarction only in
the nonreperfused group. CONCLUSIONS. Late reperfusion appeared to prevent
ventricular dilatation acute myocardial infarction independent of the
limitation of infarct size.
ARTICLES
Late reperfusion for acute myocardial infarction limits the dilatation of left ventricle without the reduction of infarct size
Cardiovascular Division, Osaka Police Hospital, Japan.
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