The Coronary Artery Revascularization Timing Effects On Left Ventricular Remodeling And Function Of Acute Myocardial Infarction

Objective:To evaluate the timing of revascularization effects on left ventricular remodeling and cardiac function in acute myocardial infarction.Methods:we studied 126 cases of patients with acute myocardial infarction who were hospitalized in our hospital emergency ward during January 2006 to November 2008.First according to different treatments they were divided into two groups,emergency PCI and delayed PCI group,then according to the period between the onset and the admission,the emergency PCI group was divided into:a group, within-6-hour group and b group,6-hour-later group.All patients had the AMI for the first time,and got admission no longer than 24 hours after the onset.Among them, the number of male cases was 104,female 22,their age was from 20 to 82,and average age was 57.35±11.43.We evaluated the level of their cardiac function according to Killip classification immediately after the admission.Patients were given PCI treatment after coronary angiography,then after the PCI and before leaving the hospital they took the cardiac ultrasound examination at any day of the 10 to 14 days after AMI.Measured the index of the heart,observed the shape of the heart,selected left ventricular ejection fraction(LVEF),left ventricular end diastolic volume (LVEDV) and left ventricular systolic volume(LVESV) as compared index, determined whether the patients had the aneurysm formation and(or) mural thrombus. And in accordance with the patient's ECG that were did during their hospitalization to determine the type of the AMI,and whether the patients had the arrhythmia and their types of arrhythmia.Results:There was no statistical significant difference within the 3 groups on their basic clinic data,including age,gender composition,the level of killip classification,risk factors,drugs in used,the days between ultrasound examination and AMI,the type of AMI(P＞0.05);There was also no statistical significant difference within the 3 groups on the severity of coronary artery change, including the number of damaged artery,IRA,availability of lateral circulation,TIMI blood flow before and after the PCI(P＞0.05);There was statistical significant difference within the 3 groups on the LVEDV,the LVESV and the LVEF(P＜0.05); The left ventricular ejection fraction of delayed PCI group significantly decreased, and the LVEDV,the LVESV increased significantly.The incidence of aneurysm formation and(or) mural thrombus of the delayed PCI group was higher than that of emergency PCI group.There was no statistical significant difference between PCI a group and b group on the formation of aneurysm.Conclusion:After balance the effects of other possible influencing factors within the 3 groups,different timings of revascularization have different effects on left ventricular remodeling and cardiac function of AMI,that is emergency PCI is better than delayed PCI at the effects on the left ventricular remodeling and cardiac function of acute myocardial infarction,and within-6-hour group is the best.