Improvement in left ventricular function following coronary stenting in patients with acute myocardial infarction: 6-month and 3-year follow-up.

BACKGROUND

This study assesses hemodynamic and angiographic changes in patients with a patent infarct-related artery (IRA) after acute myocardial infarction (AMI).

METHODS

One hundred and seventy-seven patients with first AMI, who received a predischarge stenting to the IRA and sustained a patent IRA over 3 years, were stratified into 3 groups according to the baseline left ventricular ejection fraction (LVEF): group A included 63 patients with a LVEF of >49%, group B 73 patients with a LVEF of 40%-49%, and group C 41 patients with a LVEF of <40%. The hemodynamic and angiographic parameters were compared at baseline, 6-month and 3-year follow-up.

RESULTS

The LV end-diastolic volume index increased 1, 4 and 4 ml/m(2) at 6 months and 4, 5 and 10 ml/m(2) at 3 years, respectively in group A, B and C. The LVEF increased 4%, 7% and 12% at 6 months and 6%, 8% and 14% at 3 years, respectively in group A, B and C. The stroke volume index increased 3, 7 and 12 ml/m(2) at 6 months and 6, 8 and 15 ml/m(2) at 3 years, respectively in group A, B and C. The LV wall motion score decreased 2, 3 and 3 at 6 months and was unchanged at 3 years, respectively in group A, B and C. The LV end-diastolic pressure decreased 2, 3 and 4 mm Hg, respectively in group A, B and C, at 6-month follow-up and remained stable at 3 years.

CONCLUSIONS

Long-term beneficial effects in patients receiving a late predischarge intracoronary stenting following first AMI were seen and these may be related to patent IRA. A progressive improvement in left ventricular remodeling occurs in all patients regardless of their initial left ventricular function and the improvement continues for at least 3 years.