ABSTRACT
Background: Primary percutaneous coronary intervention (PCI) has revolutionized the outcome and management of acute myocardial infarction. However, the occurrence of left ventricular dysfunction remains relatively common event following acute myocardial infarction and in associated with an adverse prognosis in these patients. this work aimed to investigate to the left ventricular dysfunction predictors following PCI for anterior myocardial infarction (AMI) using different parameters: Tissue Doppler imaging (TDI), Biomarkers (Troponin, CK-MB) and Echocardiography Methods: This research was conducted prospectively on 50 patients aged from 40 to 70 years old, presenting by first anterior myocardial infarction and treated with PCI. All cases were subjected to full history, full clinical examination, laboratory investigations, resting 12 leads electrocardiography, two dimensions echocardiography and tissue doppler imaging. Results: Highly statistically significant between EF baseline with EF on discharge and EF on discharge with after 3 months p-value was <0.001. Pre balloon dilatation, S wave of tissue Doppler imaging on discharge and S wave tissue Doppler imaging after 3 months were predictors for left ventricular systolic function. Conclusions: Persistent LV dysfunction following successful primary PCI is infrequent and is related to poor clinical outcomes at 3 months clinical follow-up. Tissue Doppler on discharge and after three months after myocardial infarction are independent predictors of LV dysfunction after anterior STEMI and can be used to predict occurrence of LV remodelling after 6 months.
ABSTRACT
BACKGROUND AND OBJECTIVES: Aggressive antithrombotic therapy and transfemoral primary intervention during acute myocardial infarction (AMI) restricts the patient's movement and may increase the risk of access site bleeding complications, and lengthen the duration of movement restriction and hospital stay. Transradial approach provides less bleeding complications and early ambulation. The purpose of this study is to know whether transradial primary intervention is safe and feasible in the patients with AMI. MATERIALS AND METHOD: From April 1998 to December 1998, transradial primary interventions were performed in the consecutive 28 patients (24 male, 57+/-7 years) by two experienced operators. The results were compared to the results of 44 (15 patients during same period, 29 during previous year) transfemoral primary interventions. RESULTS: 1)The success rates of transradial primary interventions was 93% (26/28) and comparable to 95% (42/44) of transfemoral primary interventions. 2)In transradial group, the time from the arrival of catheterization laboratory to arterial access and to reperfusion, the time from the arrival of emergency room to reperfusion were 8.1+/-3.4 minutes, 22.0+/-5.3 minutes, and 71.7+/-9.2 minutes, respectively and comparable to 9.0+/-3.1 minutes, 21.7+/-5.3 minutes, and 68.9+/-8.1 minutes of transfemoral group, respectively. 3)The complications of the procedure were treated successfully during transradial interventions. 4)In transradial group, puncture site bleeding complications were absent though heparin was continued and mild ambulation was possible early after the procedure. The hospital stay of transradial group was 5.3+/-1.3 days and shorter than 7.7+/-4.2 days of transfemoral group. CONCLUSION: In the low risk patients with AMI, transradial primary intervention might be safe and feasible with acceptable time delay by the experienced operators. It might be effective to reduce access site bleeding complications and to initiate early ambulation, resulting in the shortened hospital stay.