| Objective: The purpose of this study was to compare the clinical character, coronary artery lesion, the left ventricular function and the occurrence of cardiac events of the acute myocardial infarction (AMI) patients who received percutaneous coronary intervention therapy within 1 month of AMI with those who only received medication by coronary angiography, left ventriculography, 99mTc-methodxy isobutyl isomitrile myocardial perfusion image and equilibrium radio nuclide angiography to elucidate the effects of late reperfusion on patients with AMI and the perhaps mechanisms.Methods: 71 patients (60 male and 11 female, average age was 52.25±9.55 years old) with initial Q-wave AMI >24 hours (range from 24 hours to 1 month ;the earliest was 28 hours; the latest was 26 days; average time was 12.28±6.91 days; those ＞7 days should have unstable hemodynamics and frequently episode of angina) after onset were randomized into a PCI group (n=36) and a no-PCI group(n=35). Inclusion criteria included a history of persistent angina more than 30 minutes .The cardiac enzyme peaked more than two folds of normal range and troponin T was positive .ST-segment elevation of >0.2mv in ≥2 leads on standard 12-lead ECG should also be considered .Only patients with total occlusion of the IRA (Thrombolysis in Myocardial Infarction [TIMI] grade 0) were eligible for this study. Patients were excluded for the following reasons: 1 history of MI or cardiomyopathy; 2 severe valvular disease; 3 left bundle branch block or permanent pacemaker; 4 chronic renal failure; 5 perfusion state of the IRA exceeded TIMI grade≥1 at the initial angiography. In each group, we collected detailed clinical information including risk factors, the history of medication, QCA (the narrow more than 50 percent was positive), the record of LVEDP and the left ventricular wall movement scores (Cortina scores) through LVG. All patients underwent ERNA and MIBI MPI in 1 month and 6 month from the onset of symptoms to evaluate the heart function. In 2 groups, we compared the left ventricular wall movement scores and the ratio of acute ventricular aneurysm. We also compared the myocardial infarction area (MIA) by 99mTc-MIBI MPI and left ventricular function parameters by ERNA. We compared the cardiac events within 1 year after AMI, including cardiac death, angina, recurrent MI and the development of congestive heart failure (CHF) to assess the prognosis of the 2 groups. We used SAS 6.12 statistics software to analysis all of the data. The variables were presented as the means and the SD. Differences between group means were assessed with the t test. The x2 analysis or the fisher exact test was used to test differences between proportions. Statistical significance was indicated by P value<0.05. Results: There were no significant differences of the baseline characteristics between the 2 groups. The characteristics of CAG and LVG were similar in the 2 groups. Likewise, the MIA was also similar in the 2 groups(14.6±3.72 vs 15.12±2.63, p＞0.05). The self-comparison of respective group between 1 month and 6 month after the onset of AMI showed there were no significant differences with respective to LVEDVI, LVESVI, LVEF and LVPER in PCI group(67.13±10.16 vs 66.32±11.05,34.62±12.14 vs 34.05±10.17, 56.11±13.09 vs 57.61±11.51, 3.64±0.89 vs 3.85±0.86, p＞0.05). LVTPER and LVTPFR in 6 month were significantly smaller than those in 1 month (126.78±34.57 vs 120.64±20.93, 219.48±95.28 vs 200.86±78.66, p＜0.05). LVPFR was significantly larger(2.71±0.71 vs 3.31±0.69, P＜0.05). While in no-PCI group ,LVEDVI and LVESVI in 6 month were significantly larger than those in 1 month (69.53±14.36 vs 78.46±13.71, 37.02±15.44 vs 40.18±10.93, p<0.05) ,LVTPER,LVTPFR were also significantly larger (69.53±14.36 vs 78.46±13.71, 37.02±15.44 vs 40.18±10.93, p<0.01),and LVPER,LVPFR,LVEF were significantly smaller (3.56±0.99 vs 3.35±0.89, 2.61±0.78 vs 2.39, 52.22±13.00 vs 47.43±9.88±0.65, p<0.05). At 1 month aft... |
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