ABSTRACT
It has been well established that early restoration of patency of IRA by percutaneous coronary intervention [PCI] with recent myocardial infarction [MI] may preserve left ventricular [LV] global function and also prevent LV remodeling. There were controversies however concerning the possible benefits of delayed [within 30 days] restoration of patency of infarct-related artery of patients. To evaluate and compare the results of primary versus delayed PCI in patients with acute MI. Forty patients [35 males, 5 females mean age 50.9] were included in the study with first anterior MI, and were divided into 2 groups. Group A[20 pst] who had the chance of undergoing primary PCI within a mean 5.4 hrs from the onset of chest pain with a door to balloon time 1.6 hrs and group B[20pts] with delayed hospitization [i.e>12 hours] who nether received thrombolytic nor primary PCI, but were scheduled for routine PCI with a mean of 20.7 days. The LV function and dimensions were assessed by serial echocardiographic readings measuring LV end diastolic volume [LVEDV], LV end systolic volume [LVESV], ejection fraction [EF], regional wall motion scoring index [RWMI] at 24hrs of admission and after 3 and six months. At 3 months compared to delayed PCI group, group showed significant improvement in RWMI [from 1.9 +/- 0.3 to 1.27 +/- 0.13 in group A vs 1.6 +/- 0.2 to 1.38 0.18 in group B, p value 0.032]. There was a non significant increase in LVEDV values in the two groups, [from 101 +/- 17.6 to 109 +/- 20.1 in group A vs 98.3 +/- 22.3 to 106.3 +/- 22.1 in group B, p 0.062]. The change in EF values was nearly the same in both groups; [59.6% +/- 3.9 at base line to 58.5% +/- .5 in group A vs 57.1%9.3 to 55.2% +/- 6.4 in group B]. At six month, there was no more improvement in the RWMI in both groups but the group B showed marked increase in LVEDV [from 98.3 +/- 22.3 at base line to 138 +/- 32.96, i.e. 28.9% increase versus 15% increase in the group A [from 101 +/- 17.6 at base line to 115 +/- 32.14, p=0.041]. Where the EF% value was nearly preserved in group A [59.6% +/- 3.9 at base line to 59.9% +/- 6.81], there was remarkable deterioration in the EF% in the delayed group [from 57.1 +/- 9.3 at base line to 51.8 +/- 10.8, p 0.008] after six month. Despite the enthusiasm to the concept of restoring patency of infarct related artery irrespective of time, our data showed that early and immediate revascularization [primary PCI] is superior to delayed intervention. Therefore prompt restoration of patency is highly recommended for myocardial salvage and preserving LV function