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  • Title: [Does the treatment delay influence reperfusion efficacy and short- and long-term left ventricular function in patients with anterior myocardial infarction treated with primary coronary angioplasty?].
    Author: Araszkiewicz A, Lesiak M, Grajek S, Mularek-Kubzdela T, Oko-Sarnowska Z, Trojnarska O, Popiel M, Cieśliński A.
    Journal: Pol Arch Med Wewn; 2004 Dec; 112(6):1407-13. PubMed ID: 15962605.
    Abstract:
    UNLABELLED: The benefit of thrombolysis in acute myocardial infarction (AMI) is time dependent, but there is lack of evidence of such a close correlation in patients undergoing primary percutaneous transluminal coronary angioplasty (pPTCA). The aim of this study was to evaluate the importance of delay of treatment for myocardial reperfusion and early and late ventricular function in patients with anterior AMI treated with pPTCA. METHODS: 106 consecutive patients (76 men, 30 women, age 63 +/- 11 years) treated with pPTCA for anterior AMI was included in this study. We evaluated angiographic (myocardial blush grade (MBG), TIMI flow, corrected TIMI frame count) and electrocardiographic (resolution of ST segment elevation--nST) markers of myocardial reperfusion. Echocardiography was performed 3 and 180 days after pPTCA. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction were calculated. Patients were divided into three groups: group A (41 pts.) reperfused within 3 hours, group B (40 pts.) reperfused between 3-6 hours, group C (25 pts.) reperfused between 6-12 hours from symptoms onset. RESULTS: MBG 0-1 (lack of myocardial reperfusion) was significantly more common in group B and C, compared with group A (p = 0.002). The incidence of nST was higher in group A (p < 0.0001). The EF after 3 days (p = 0.03) and after 6 months (p = 0.04) was better in group A in comparison to group C. There was not significant difference in EDV after 3 days, but after 6 months EDV was significantly higher in group C (p = 0.02). CONCLUSIONS: The delay of treatment over 3 hours is associated with decreasing of myocardial reperfusion efficacy and deterioration of the early and late LV function.
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