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Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Bolognese, Leonardo Carrabba, Nazario Parodi, Guido Santoro, Giovanni Maria Buonamici, Piergiovanni Cerisano, Giampaolo Antoniucci, David |
| Copyright Year | 2004 |
| Abstract | BACKGROUND We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction. METHODS AND RESULTS Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty [PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0=not visible, 1=patchy, 2=homogeneous contrast effect) within the area at risk. An MCESI > or =1 was considered adequate reperfusion. Mean follow-up was 46+/-32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD). MD patients had a higher mean creatine kinase (4153+/-2422 versus 2743+/-1774 U/L; P=0.002) and baseline wall-motion score index (2.61+/-0.31 versus 2.25+/-0.42; P<0.001) and a lower baseline ejection fraction (33+/-8% versus 40+/-7%; P<0.001). From day 1 on, LV volumes progressively increased in the MD patients (n=19) and were larger than those of NoMD patients (n=85) at 6 months (end-diastolic volume 170+/-55 versus 115+/-29 mL; P<0.001). MCESI was the most important independent predictor of LV dilation (OR 0.61, 95% CI 0.52 to 0.71, P<0.000001). By Cox analysis, MD represented the only predictor of cardiac death (OR 0.26, 95% CI 0.09 to 0.72, P=0.010) and combined events (cardiac death, reinfarction, and heart failure; OR 0.44, 95% CI 0.23 to 0.85, P=0.014). MD patients showed worse survival in terms of cardiac death (P<0.0001) and combined events (P<0.0001). CONCLUSIONS In reperfused acute myocardial infarction, MD within the risk area is an important predictor of both LV remodeling and unfavorable long-term outcome. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/109/9/1121.full.pdf?download=true |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/109/9/1121.full.pdf |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/early/2004/02/16/01.CIR.0000118496.44135.A7.full.pdf?cited-by=yes&legid=circulationaha%3B01.CIR.0000118496.44135.A7v1 |
| PubMed reference number | 14967718v1 |
| Volume Number | 109 |
| Issue Number | 9 |
| Journal | Circulation |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Amiodarone Biologic Preservation Cardiac Death Cardiomyopathies Coronary Artery Disease Creatine Kinase Diastole Ejection fraction (procedure) Heart failure Large Myocardial Infarction Myocardium Pathological Dilatation Patients Percutaneous Transluminal Coronary Angioplasty Reperfusion Therapy Ventricular Dysfunction, Left Ventricular Remodeling |
| Content Type | Text |
| Resource Type | Article |
