ABSTRACT
Patients with acute myocardial infarction (n=161) were in random order divided into 2 groups: (1) those who received thrombolytic therapy (TT), (n=126), (2) those who received TT, optimized coronary angioplasty (TT+CA) on days 2-7 (n=35). During hospital period we assessed systolic and diastolic left ventricular (LV) function, content of cytokine tumor necrosis factor a (TNF a) and its soluble receptor type I (sTNF alphaR-I). Outcomes were registered after 1 year. By the end of hospital period group 2 had significantly higher LV ejection fraction, smaller left atrial dimensions, and lower pulmonary artery pressure. Zones of disturbances of local contractility were more rarely registered in this group. No significant differences were revealed between groups 1 and 2 in parameters of LV diastolic function, levels of TNF alpha and sTNF alphaR-I were revealed by the end of hospital period. After 1 year end point (cardiac death/reinfarction/revascularization) was noted in 47.5% of patients of group 1 and only in 20% of patients in group 2 (relative risk 0.48; 95% confidence interval 0.21-0.84, p=0.0035). Thus delayed CA after TT in acute myocardial infarction is an effective method of reperfusion therapy.
