perfusionPerfusion and kinetic variations of left ventricle after primary PCI for acute myocardial infarction: correlation between clinico-angiographic and scintigraphic parameters

Background: The aim of the present study was to evaluate which of the clinico-angiographic parameters of acute ischemic extension and efficacy of reperfusion in AMI treated with primary PCI are predictive of infarct size and one month left ventricular ejection fraction (LVEF). Patients and Method: Thirty-five patients with first AMI treated with primary PCI underwent two rest 99mTc-sestamibi gated SPECT, 4-6 days and 30-40 days after PCI. Clinical, electrocardiographic, angiographic and scintigraphic parameters for ischemic extent in acute phase, effective reperfusion, perfusional and kinetic outcome were collected. Results: There was a significant linear correlation among indices of initial ischemic extension and early perfusion defect and infarct size, while time to treatment (symptom onset to balloon) correlated with reperfusion indices (ST resolution, corrected TIMI frame count cTFC, myocardial perfusion grade MPG) and with late functional outcomes (smaller infarct size and better LVEF). A time to treatment of < 240 minutes was the most accurate predictor of effective reperfusion and functional outcome. A late LVEF ?50% was correlated with sum of ST elevation, ST resolution, time to treatment, CK-MB peak value, early LVEF, and early and late infarct size. An improvement in LVEF in 1 month was seen in 60% of patients, who showed a shorter time to treatment and a lower cTFC. Conclusions: Improvements of perfusion and left ventricular function were frequent one month after primary PCI in AMI. A total ischemic time ?240 minutes and secondary ST resolution and angiographic parameters of effective reperfusion were the best indicators of infarct size, late LVEF and improvement of LVEF.