Increasingly Well-Preserved Left Ventricular Function in Hospital Survivors With Acute Myocardial Infarction Effect of Early and Complete Reperfusion Strategy on Left Ventricular Remodeling

Shigemasa Tani; Ken Nagao; Ikuyoshi Watanabe; Kimio Kikushima; Kazuhiro Watanabe; Takeo Anazawa; Hirofumi Kawamata; Eizo Tachibana; Michiaki Matsumoto; Takamichi Kumabe; Katsuo Kanmatsuse; Toshio Kushiro

doi:10.1253/circj.71.180

Clinical Investigation

Increasingly Well-Preserved Left Ventricular Function in Hospital Survivors With Acute Myocardial Infarction

Effect of Early and Complete Reperfusion Strategy on Left Ventricular Remodeling

Shigemasa Tani, Ken Nagao, Ikuyoshi Watanabe, Kimio Kikushima, Kazuhiro Watanabe, Takeo Anazawa, Hirofumi Kawamata, Eizo Tachibana, Michiaki Matsumoto, Takamichi Kumabe, Katsuo Kanmatsuse, Toshio Kushiro

Author information

Shigemasa Tani
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Ken Nagao
Emergency and Critical Care Medicine, Nihon University Surugadai Hospital
Ikuyoshi Watanabe
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Kimio Kikushima
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Kazuhiro Watanabe
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Takeo Anazawa
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Hirofumi Kawamata
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Eizo Tachibana
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Michiaki Matsumoto
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Takamichi Kumabe
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Katsuo Kanmatsuse
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital
Toshio Kushiro
Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Department of Cardiology, Nihon University Surugadai Hospital

Keywords: Acute myocardial infarction, Coronary reperfusion therapy, Left ventricular remodeling

JOURNAL FREE ACCESS

2007 Volume 71 Issue 2 Pages 180-185

DOI https://doi.org/10.1253/circj.71.180

Details

Abstract

Background Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI. Methods and Results The study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55±14, 58±13, 59±13, 61±13%, p<0.001; 98±30, 94±27, 90±31, 76±27 ml/m², p<0.0001). Multiregression analysis revealed that shortening of the door-to-Thrombolysis In Myocardial Infarction (TIMI)-3 time (time interval from arrival at the emergency room until patients achieved TIMI-3 flow) and achieving substantial TIMI-3 flow were independent predictors for LV remodeling. Conclusion Although this was a retrospective analysis, the results demonstrated that the change in reperfusion therapy aiming at complete reperfusion at an earlier stage after AMI onset has contributed to improving post-MI remodeling. (Circ J 2007; 71: 180 - 185)

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