Author + information
- Received June 19, 1997
- Revision received October 1, 1997
- Accepted October 13, 1998
- Published online February 1, 1998.
- Luciano Agati, MDA,* (, )
- Paolo Voci, MD, PhDA,
- Patrick Hickle, MDB,
- Dario C. Vizza, MDA,
- Camillo Autore, MDA,
- Francesco Fedele, MDA,
- Steven B. Feinstein, MDB and
- Armando Dagianti, MDA
- ↵*Dr. Luciano Agati, Department of Cardiovascular and Respiratory Sciences, “La Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Objectives. This study sought to compare the impact of primary coronary angioplasty and thrombolytic therapy for acute myocardial infarction (AMI) on 1-month infarct size and microvascular perfusion.
Background. The effect of the reperfusion strategies of primary coronary angioplasty and thrombolytic therapy on microvascular integrity still remains to be determined.
Methods. Sixty-two consecutive patients with a first AMI, undergoing intravenous tissue-type plasminogen activator (t-PA) therapy (32 patients, Group I) or primary angioplasty (30 patients, Group II), were studied. Only patients with 1-month Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 were selected for the study. Patients in whom primary angioplasty was unsuccessful or those with clinical evidence of failed reperfusion were excluded. Microvascular perfusion was assessed at 1 month by intracoronary injection of sonicated microbubbles. Contrast score index (CSI) and wall motion score index (WMSI) were derived using qualitative methods.
Results. At baseline there were no significant differences between groups for age, risk factors, time to hospital presentation, Killip class on admission, prevalence of multivessel disease or anterior infarct site, infarct area extension before reperfusion, peak creatine kinase levels and postinfarction treatment. Conversely, significant differences between groups were found at follow-up for percent residual infarct related-artery (IRA) stenosis (70 ± 12 vs 36 ± 14 [mean ± SD], p = 0.0001), CSI (1.02 ± 0.4 vs. 1.49 ± 0.5, p = 0.0003) and WMSI (1.67 ± 0.3 vs. 1.45 ± 0.3, p = 0.015). In particular, in the subset of patients with TIMI grade 3 flow, a perfusion defect occurred in one or more segments subtended by the IRA in 72% of Group I versus 31% of Group II patients (p < 0.00001) and in 27% of Group I versus 8% of Group II segments (p < 0.00001).
Conclusions. The present study shows, in a highly selected cohort with successful IRA recanalization, that primary angioplasty is more effective than thrombolysis in preserving microvascular flow and preventing extension of myocardial damage at 1-month after AMI.
This study was presented in part at the 69th Annual Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 1996.
- Received June 19, 1997.
- Revision received October 1, 1997.
- Accepted October 13, 1998.
- The American College of Cardiology