Determinants of Left Ventricular Functional Recovery After Thrombolytic Therapy and/or Immediate Coronary Angioplasty in Acute Myocardial Infarction

To determine the effect of thrombolytic therapy and/or immediate coronary angioplasty (PTCA) on left ventricular function, 129 patients with acute transmural myocardial infarction were retrospectively studied. Treatment strategies included thrombolytic therapy alone (n = 29), PTCA alone (n = 41), and combined thrombolytic therapy and PTCA (n = 59). Left ventricular ejection fraction (LVEF) and infarct zone regional wall motion (RWM) were determined from contrast ventriculography obtained acutely and at day 7–10. In the overall group, there was a 2 ± 9% increase in LVEF (p < 0.02) and a 0.7 ± 1.2 SD/chord increase in RWM (p < 0.0001) between day 1 and day J‐10. Patients with a patent infarct vessel at day 7–10 had a more significant change (Δ) in LVEF (3 ± 8 vs −5 ± 9%, p = 0.0002) and RWM (0.8 ± 1.2 vs 0.1 ± 1.0 SD/chord, p < 0.02) than patients with an occluded vessel. Patients with a residual stenosis < 70% at day 7–10 manifested a greater ΔLVEF (3 ± 8vs‐5 ± 9%, p < 0.01) and ΔRWN (0.9 ± 1.2 vs 0.1 ± 1.0 SD/ chord, p < 0.05) than patients who were occluded. There was a negative correlation between residual stenosis and ΔRWM (p < 0.04). Patients treated < 3 hours after symptom onset demonstrated a more significant ΔRWM when compared to patients treated ≥ 3 hours (1.0 ± 1.3 vs 0.5 ± 1.1 SD/chord, p < 0.04). Patients treated with combined thrombolytic therapy and PTCA were observed to have a greater ARWM than patients treated with thrombolytic therapy alone (0.8 ± 1.2 vs 0.2 ±0.9 SD/chord, p < 0.05). Patients with an LVEF > 40% demonstrated a more significant ΔLVEF than patients; ± 40% (7 ± 8vs 1 ± 8%, p < 0.007). A significant improvement in ΔLVEF was noted only in patients with an anterior infarction when compared to patients with an inferior infarction. Age, sex, presence of multivessel disease, history of prior myocardial infarction, initial patency of the infarct vessel, and presence of collaterals had no effect on left ventricular function. Stepwise multiple regression identified residual stenosis, time to treatment, and the degree of initial global impairment as the major joint predictors of ventricular functional recovery. (J Interven Cardiol 1988:1:3)