The effect of facilitated percutaneous coronary intervention on systolic synchrony performance in patients with acute myocardial infarction

Abstract

Objective To evaluate the influence of thrombolysis,primary PCI and facilitated PCI via a transradial approach therapy on systolic performance and synchrony in patients with AMI using ERNA.Methods A total of 213 patients with their first anterior AMI were enrolled in this study.Seventy patients were randomized to a thrombolytic treatment group,71 patients to a primary PCI group and 72 patients to a facilitated PCI group.At 1 week and 28 weeks after AMI onset,parameters of the LVEF,peak ejection rate (PER),time to peak ejection rate (TPER),peak filling rate (PFR),time to peak filling rate (TPFR)and left ventricular systolic synchrony (LVSS) (PS,FWHM,PSD) were measured by ERNA with ventricular phase analysis.Major adverse cardiac events (MACE) such as post AMI angina,recurrence of MI or mortality were recorded.The t-test was used to compare the data.Results (1) There were no significant differences among the three groups in clinical characteristics.(2) The first CAG showed that the grade of the infarct related artery (IRA) in the primary PCI group (8.45％,6/71) was significantly lower than that in the thrombolytic treatment group (31.43％,22/70) (x2=11.69,P＜0.01) and also lower than that in the facilitated PCI group (30.56％,22/72) (x2 =11.09,P＜0.01).The TIMI-3 grade rate of IRA post PCI in the facilitated PCI group (98.61％,71/72) was higher than that in the primary PCI group (88.73％,63/71),x2=4.35,P＜0.05.(3) At 28 weeks after AMI,LVEF increased significantly from (42.75±3.47)％ to (50.45±6.23)％ (t=2.08,P＜0.05) and PER from (2.18±0.08) EDV/s to ( 2.68±0.11) EDV/s (t=2.13,P＜0.05) in the facilitated PCL group,while TPER,PS and PSD decreased significantly from (168±15) ms to (151±16) ms,(46.28±12.33)°to (41.92±16.75)°,(10.77±4.26)°to (9.14±1.28)° respectively(t=2.10,2.19,2.45,all P＜0.05),when compared with those in the primary PCI group.(4) The incidence of MACE in the 28 week follow-up in the facilitated PCI group(8.33％,6/72; x2 =35.05,P＜0.001) and primary PCI group (8.45％,6/71 ; x2 =34.49,P＜0.001)was significantly lower than that in the thrombolytic treatment group (54.29％,38/70).Conclusion Facilitated PCI via a transradial approach therapy might significantly inhibit left ventricular remodeling and improve the left ventricular function and systolic synchrony by the complete,persistent patency of IRA,which was superior to primary PCI or thrombolytic treatment therapy. Key words: Myocardial infarction; Myocardial contraction; Angioplasty,transluminal,percutaneous coronary; Thrombolytic therapy; Radionuclide ventriculography