급성심근경색증에서 대기성 경피적관동맥성형술이 좌심실 기능에 미치는 효과 = Effect of Delayed Percutaneous Transluminal Coronary Angioplasty on Left Ventricular Function After Acute Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Primary and rescue percutaneous transluminal coronary angioplasty (PTCA) after acute myocardial infarction (AMI) improves left ventricular (LA) function and survival by restoring blood flow to the infarct-related artery (IRA). However, the effect of delayed PTCA is unclear. The purpose of this study was to investigate whether delayed PTCA after AMI improves LV function. PTCA was performed before discharge in thirty patients with residual myocardial ischemia on noninvasive tests after the first attack of AMI. Follow-up coronary angiography and left ventriculography were done between six months and one year after PTCA. Degree of the coronary artery stenosis, LV ejection fraction (LVEF), regional wall motion score (RWMS), and LV end-diastolic pressure (LVEDP) were measured. At follow-up LV function was improved; LVEF from 59.6±10.8% to 66.4±13.6 (p<0.05), RWMS from 0.29±0.03cm/chord to 0.56±0.50cm/chord (p<0.05). LVEDP was decreased from 17.4±6.9mmHg to 14.4±6.9mmHg, however, this was not statistically significant. Restenosis occurred in 16 patients (53%). In patients without restenosis, LV function was improved; LVEF from 61.8±9.7% to 72.3±11.0% (p<0.05), RWMS from 0.31±0.12cm/chord to 0.82±0.54cm/chord (p<0.05), and LVEDP from 16.6±5.8mmHg to 13.4±5.8mmHg (p<0.05). However, in patients with restenosis these parameters of LV function were not changed significantly. Use of angiotension converting enzyme inhibitor (ACEI) increased LVEF from 61.8±9.7% to 72.3±11.0% (p<0.05) and decreased LVEDP from 17.8±5.1mmHg to 13.4±6.3mmHg (p<0.05) in patients without restenosis. In conclusion, delayed PTCA of the IRA in patients with residual ischemia after AMI and use of ACEI can improve LV function and long-term survival.