Analysis Of Clinical Outcome Of Late Coronary Stenting In Patients With Acute Myocardial Infarction

Objective: Approximately two thirds of all patients admited with acute myocardial infarction(AMI) can't obtain benefits from myocardial salvage because of early insufficient reperfusion of infarction related artery(IRA), by contrast, the role of late coronary stenting after AMI remains controversial. The purpose of this study was to explore the possible clinical implication by evaluating the effects of late coronary stenting on left ventricular remodeling and clinical events.Methods: The clinical outcome was compared between patients with (25 patients, stenting group) and without (19 patients, control group) late coronary stenting after AMI .Optimal medical therpy for all patients included drugs known to carry prognostic benefits after AMI. Patients presented at baseline, one month and six months of follow-up for 99Tcm-MIBI myocardial imaging estimates of left ventricular size and function and for assesments of clinical events and other data.Results: (1) Patient baseline characteristics. The baseline characteristics including age, gender, blood pressure, use of beta-adrenergic blocker and ACE-I therapy, infarction zone and left ventricular end-systolic volume were similar in the two groups. (2) Results of intervention. 30 stents were implanted into 25 patients with late percutaneous coronary intervention(PCI) after AMI, pre- and post-procedual diameter stenosis were (96±4.56)% and 0%, TIMI flow grades 3 was only 11.3% before the procedure while 100% after that, there were no death, myocardial infarction or recanalization during in-hospital. (3) Left ventricular size and function. Left ventricular end-diastolic volume(EDV, p=0.825), end-systolic volume(ESV, p=0.973) and ejection fraction(EF, p=0.737) were similar between the two groups, no significantchanges in EDV(p=0.152), ESV(p=0.164) and EF(p=0.220) were observed within the two groups during the time interval of follow-up. (4) Clinical events. During a follow-up duration of (10.4±3.5) months, combined event rate (including death, myocardial infarction, stroke, heart failure, angina pectoris) favors a policy of coronary stenting therpy (24% VS 57.9%, p=0.02). Conclusion: Late coronary stenting of IRA after AMI is an effective and safe therapy, there are less combined event rate than medical therapy alone, this outcome can promote our furthur clinical practice. But our study didn't demonstrate the benefit effect on left ventricular remodeling , therefore, the implication of late PCI after AMI, especially the effect on left ventricular remodeling, needs to be furthur tested.