open access

Vol 20, No 5 (2013)
Original articles
Published online: 2013-09-30
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Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: A pooled analysis of cardiovascular magnetic resonance studies

Łukasz A. Małek, Joao C. Silva, Nick G. Bellenger, Jose C. Nicolau, Mariusz Kłopotowski, Mateusz Śpiewak, Carlos H. Rassi, Zbigniew Lewandowski, Mariusz Kruk, Carlos E. Rochitte, Witold Rużyłło, Adam Witkowski
DOI: 10.5603/CJ.2013.0141
·
Cardiol J 2013;20(5):552-559.

open access

Vol 20, No 5 (2013)
Original articles
Published online: 2013-09-30

Abstract

Background: The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR).

Methods: The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6–12 months.

Results: Late PCI with OMT led to improved LVEF (+5 ± 7% vs. –1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (–11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (–7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion.

Conclusions: In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone.

Abstract

Background: The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR).

Methods: The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6–12 months.

Results: Late PCI with OMT led to improved LVEF (+5 ± 7% vs. –1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (–11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (–7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion.

Conclusions: In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone.

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Keywords

myocardial infarction, occluded artery, infarct-related artery, viability, percutaneous coronary intervention, optimal medical treatment

About this article
Title

Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: A pooled analysis of cardiovascular magnetic resonance studies

Journal

Cardiology Journal

Issue

Vol 20, No 5 (2013)

Pages

552-559

Published online

2013-09-30

DOI

10.5603/CJ.2013.0141

Bibliographic record

Cardiol J 2013;20(5):552-559.

Keywords

myocardial infarction
occluded artery
infarct-related artery
viability
percutaneous coronary intervention
optimal medical treatment

Authors

Łukasz A. Małek
Joao C. Silva
Nick G. Bellenger
Jose C. Nicolau
Mariusz Kłopotowski
Mateusz Śpiewak
Carlos H. Rassi
Zbigniew Lewandowski
Mariusz Kruk
Carlos E. Rochitte
Witold Rużyłło
Adam Witkowski

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