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After thrombolysis for acute myocardial infarction (AMI) it has been demonstrated that without revascularization viability in the infarct area can be lost. We sought to determine the effect of revascularization on the process of left ventricular remodeling in patients with viability in the infarct-area in the early phase after AMI.
We prospectively investigated 224 patients who were included in the VIAMI-trial (multicenter, randomized controlled clinical trial). (Trials 2012; 13:1). Patients in the VIAMI-study did not undergo a primary or rescue PCI and were stable in the early in-hospital phase. Patients underwent a low-dose dobutamine echocardiography for the detection of viability within 72 hours after AMI. Patients with viability were randomized to an invasive strategy (culprit vessel stenting) or a conservative strategy (ischemia guided approach). Patients without viability were followed as a registry group. Follow up (FU) echocardiography was performed at a mean of 205 days. For the purpose of this substudy patients were divided in three groups. Group 1: viable and revascularized before FU. Group 2: viable but medically treated. Group 3: non-viable patients.
Group 1 showed preservation of left ventricular (LV) volume indices. The ejection fraction (EF) increased significantly from 54.0% to 57.5% (p=0.047). Group 2 showed a significant increase in LV volume indices with no improvement in EF (53.3% vs. 53.0%, p=0.86). Group 3 showed a significant increase in LV volume indices, with a decrease in EF from 53.5% to 49.1% (p=0.043). Multivariate logistic regression analysis indicated the number of viable segments and revascularization during FU as independent predictors for EF improvement, especially in patients with lower EF at baseline.
Viability early after acute myocardial infarction is associated with improvement in LV function after revascularization. When viable myocardium is not revascularized, the LV tends to remodel with increased LV volumes, without improvement of EF. Absence of viability results in ventricular dilatation and deterioration of EF.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: ACS Therapy: No Reflow and Improving Outcomes
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1214-184
- 2013 American College of Cardiology Foundation