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JCU 1994 ;2(2) :115-128.
A Study on the Delayed Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction
Joo Hyung Park, Gwang Chae Gill, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang
Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea
ABSTRACT
Background : Early reperfusion after acute myocardial infarction is known to be effective in salvaging myocardium and hence improving early and late mortality and morbidity. The late reperfusion by percutaneous transluminal coronary angioplasty(PTCA) is also reported to be helpful in improving mortality and morbidity also, however the exact mechanism is not kmown when the salvage of myocardium is not expected. Methods : In this study, 24 acute myocardial infarction patients who had not been undergone reperfusion therapy within 6 hours or those who had been failed to be recanalized were subjected to study. The patients were divided into two groups, group I, those who had little ischemic myocardium around the infarct(11 patients, all male, 59.1±9.8years) and group II, those who had considerable ischemic area around the infarct zone(13 patients, M : F=3.3 : 1, 60.9±9.7years) revealed by myocardial perfusion scanning with 201TI of 99mTC-MIBI. The area of ischemia and infarction, defect volume ratio and left ventricular dimensions global functions were measured before and after PTCA. The mortality and morbidity were also abserved. Results : In group I the associated risk factors were hypertension in 5, hypercholesterolemia, 2 and smoking, 5 patients and in group II hypertension in 5, hypercholesterolemia, 4, smoking, 7 and diabetes mellitus, 2 patients. The PTCA was peformed 10.2±4.9days in proup I and 10.5±6.6days in group II after the admission. The infarct related arteries were left anterior descending artery in 12, left circumflex artery in 2 and right coronary artery in 10. Echocardiographic variables, i.e. left ventricular end-diastolic volume, left ventricular end-systolic volume, ejection fraction of the left ventricle and the E to A ratio of mitral flow measured by doppler echocardiography were compared before and after PTCA in each group. The variables were not differnt between two groups and were not changed after PTCA. Myocardial perfusion scanning revealed significantly decreased defect area(p<0.05), infarct area(p<0.005) and defect volume ratio(p<0.05)after PTCA in group II. In group I, 6 patients out of 11 showed improved infarct area and defect volume ratio, but the mean of the group was not different before and after PTCA. There was neither mortality nor nonfatal infarction during follow up period of 15.9±3.8months in group I and 13.8±3.8months in group II. Conclusion : Above results suggested that the delayed PTCA was efficacious in reducing perfusion defect area, infarct area and defect volume ratio in group II and in some patients of group I also and that the delayed PTCA might be effective in preventing further dilation of the left ventricle and further deterioration of the left ventricular functions in either group of the patients.
Keywords: Delayed PTCA, Myocardial perfusion, Left ventricular function
Volume 25, No 3
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