Equilibrium Radionuclide Angiography for Evaluating the Effect of Facilitated Percutaneous Coronary Intervention on Ventricular Synchrony in Patients With Acute Myocardial Infarction

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp eft ventricular (LV) remodeling after acute myocardial infarction (AMI) is a pathophysiologic process caused by contractive stretching between normal and necrotic/ ischemic myocardium around the infarcted area. As a result, the ventricle loses mechanical synchronization, which causes further deterioration in the hemodynamic abnormality. Therefore, LV remodeling is considered to be the main determinative factor for cardiac accident and long-term poor outcomes after AMI. 1 The key management technique to protect ventricular function and synchrony is to reperfuse the ischemic myocardium as soon as possible by recanalizing the infarct-related artery (IRA). 2-5 Although intravenous thrombolytic therapy is simple, convenient and economic, the rate of patency of the IRA with TIMI grade II flow is only 50-70% in only half of these patients. 6 Conversely, ischemic recurrence and IRA reocclusion may occur in 15-30% of them. Although primary percutaneous coronary intervention (PCI) can completely and persistently reopen the IRA, reperfusion is delayed up to 40-60 min as compared with thrombolytic treatment. Although facilitated PCI, which combines thrombolytic therapy and primary PCI, was once expected to preserve ventricular function and improve prognosis, the ASSENT-4 trial evaluating facilitated PCI after standard-dose thrombolytic infusion failed to find benefit at 90 days, 7 and primary PCI was claimed to be superior to pre-intervention thrombolysis for long-term prognosis through 5 years of follow-up. 8 However, it is unclear whether reduced-dose reteplase, combined with primary PCI, is preferable to either of them in opening the IRA, and in improving ventricular function. In the present study, we evaluated the influence of primary PCI and facilitated PCI (half-dose reteplase) on the cardiac function and synchronization, with the aim of providing reliable data on the strategy for protecting ventricular performance.

Reperfusion strategies in patients with ST-segment elevation myocardial infarction during hospitalization in China: Findings from the Improving Care for Cardiovascular disease in China (CCC)-Acute Cronary Synrome project

“…PI-PCI can shorten the time of myocardial ischemia, significantly reduce the occurrence of no-reflow, markedly increase the proportion of TIMI 3 flow, expand the subsequent PCI time by early thrombolysis, and reduce the mortality rate. 31 Therefore, for patients who cannot perform timely PCI, the reperfusion strategy of PI-PCI is relatively effective and safe. The factors needs to be considered including symptom-onset to first medical contact time, expected time of transfer to a PCI-capable hospital, and patients risk factors.…”