Relationship between tissue reperfusion and postinfarction left ventricular remodelling in patients with anterior wall myocardial infarction treated with primary coronary angioplasty.

INTRODUCTION: Pathological left ventricular remodelling is considered the main cause of heart failure in patients after myocardial infarction. AIM: The purpose of this study was to evaluate correlations between the degree of coronary microvascular reperfusion assessed by means of the angiographic myocardial blush grade (MBG) scale and adverse left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary angioplasty. METHODS: This study involved 92 consecutive patients, hospitalised because of their first anterior wall myocardial infarction, who underwent successful (TIMI-3 grade flow) primary coronary angioplasty. Angiographic myocardial reperfusion parameters (MBG, corrected TIMI Frame Count) were assessed. Three days and 6 months after the index PCI all patients underwent an echocardiographic examination and such parameters as end-diastolic volume (EDV), left ventricular ejection fraction (EF) and contractility index (WMSI) were calculated. RESULTS: The patients were divided into two groups: group 1 with impaired myocardial reperfusion (MBG 0-1) (n=32) and group 2 with adequate tissue reperfusion (MBG 2-3) (n=60). Negative left ventricular remodelling was observed more frequently in group 1 than in group 2 (28.1% vs 10%, p=0.029). More patients in group 1 presented heart failure symptoms (56.3% vs 25%, p=0.013). CONCLUSIONS: Failure of tissue reperfusion assessed by means of angiographic indices (MBG 0-1) in patients with myocardial infarction treated with primary coronary angioplasty is associated with a higher rate of adverse myocardial remodelling and heart failure at 6 months after myocardial infarction.