Effectiveness of Delayed in Comparison with Early Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

الملخص

Background: Acute myocardial infarction is world wild leading cause of death and the incidence of mortality have declined dramatically over the last 30 years, with the advent of the coronary care unit, fibrinolytic therapy, catheter-based reperfusion including primary percutaneous coronary intervention, and statin therapy. Early revascularization is critically important in the management of patients presenting with acute myocardial infarction.81Aim: To assess the benefit of delayed in comparison with early primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction.Methods: This prospective study included 82 patients with acute ST elevation myocardial infarction they were selected from those who had admitted to the coronary care unit of Shaheed Al-Mehrap cardiac center in Babylon-Iraq during a period between November 2013 and November 2014, they divided in to two groups according to the time of intervention that done, first group include patients underwent primary percutaneous coronary intervention within less than 12 hours from the onset of acute myocardial infarction and second group include patients underwent primary percutaneous coronary intervention between 12 and 48 hours from the onset. Ejection fraction, left ventricle end diastolic dimension, and functional class compared at presentation, after 2 and 6 months.
Results: The mean ejection fraction in first group were 55%, 59% and 60% at presentation, after 2 and 6 months respectively with statistical analysis that shows significant improvement in ejection fractions with P-value < 0.05. The mean ejection fraction in second group were 48%, 50% and 50% at presentation and after 2 and 6 months respectively with no significant improvement in the ejection fraction, P-value > 0.05% . The mean left ventricular end diastolic dimension divided by patient`s height in first group were 3.02 cm/m, 3.20 cm/m and 3.25 cm/m at presentation and after 2 and 6 months respectively and in second group were 2.94 cm/m, 3.09 and 3.19 at presentation, and after 2 and 6 months respectively. The statistical analysis shows significant difference between both groups regarding mean left ventricular end diastolic dimension at presentation and after 2 months, P-value < 0.05, while there is no significant difference after 6 months, P-value > 0.05. In the second group, there is significant improvement in the ejection fraction of subgroup (at presentation and after 6 months) between 30 and 39%, P-value < 0.05. There is significant improvement in functional class of second group after 6 months, P-value < 0.05.
Conclusions: In case of ST-elevation myocardial infarction, delayed primary percutaneous coronary intervention may improve functional class, left ventricular size and even ejection fraction. Primary percutaneous coronary intervention, indicate more improvement in left ventricular ejection fraction, size and remodeling, and functional class