Document Type : Original Article
Zagazig university. Faculty of medicine, cardiology department
Cardiology, Zagazig university
Professor, Cardiology, Zagazig
Lecturer of Cardiology, Faculty of medicine, Zagazig university
Background: The preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPCI). Another mode is transfer for immediate angioplasty following thrombolytic therapy (Pharmaco-invasive PCI).
Objective: to assess the short-term recovery of left ventricular systolic and diastolic functions following primary versus pharmaco-invasive PCI
Subjects and methods: We enrolled one hundred patients admitted to Zagazig university hospital, Egypt with anterior STEMI . first group underwent primary PCI and the second group underwent pharmaco-invasive PCI w. Both groups were followed-up for three months to assess systolic and diastolic myocardial recovery. Systolic function was assessed by EF and GLS. Diastolic function as assessed by E/e` ratio. A unique Doppler index addressing both systolic and diastolic functions [E/(e'×s')] index assessed.
Results: After revascularization there was a modest improvement in all parameters without significant difference regarding ejection fraction, but there was a statistically significant difference between the two groups regarding GLS, E/e` ratio and E/(e`x s`) ratio with a P value of 0.02, 0.003 and 0.004 respectively. Three months later, there was improvement in the EF and GLS with significant difference between the two groups regarding the GLS, E/e` ratio and E/(e`x s`) ratio with a P value of 0.03, <0.001and <0.001 respectively. Multivariate analysis showed that GLS after revascularization and both E/(e`x s`) ratio immediately and 3 months after revascularization were the most powerful predictors for MACE. The optimal cut-off for E/(e`×s`) to predict MACE was 1.72
Conclusion: Pharmaco-invasive PCI constitutes a reliable reperfusion strategy for patients presenting with anterior STEMI