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 ventricularfunction. 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 (R WM) 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 f 1.2 SD/chord increase in R WM (p < 0.0001) between day 1 and day 7-10. Patients with a patent infarct vessel at day 7-10 had a more significant change (A) in LVEF (3 f 8 vs -5 & 996, p = 0.0002) and RWM (0.8 f 1.2 vs 0.1 A 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 M V E F (3 f 8 vs -5 f 9%. p < 0.01) and ARWW (0.9 k 1.2 vs 0.1 1.0 SD/ chord, p < 0.05) than patients who were occluded. There was a negative correlation between residual