Abstract 4232: Incidence, Determinants and Prognostic Value of Reverse Left Ventricular Remodeling after Primary Percutaneous Coronary Intervention
Purpose: Few data are available on the extent and prognostic value of reverse left ventricular remodeling (r-LVR) after after ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated.
Methods: Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 hrs of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodeling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up.
Results: R-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P <0.05). Cox analysis identified r-LVR as the only independent predictors of 2-year event free survival (HR 3.42, 95% CI 1.08 to 10.8, P=0.037)
Conclusions: R-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favorable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.