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Left ventricular remodeling in the elderly with acute anterior myocardial infarction treated with primary coronary intervention

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Abstract

We compared left ventricular (LV) remodeling following a first time acute anterior ST-elevation myocardial infarction (aSTEMI) treated with primary coronary intervention (pPCI) in different age groups. A total of 116 patients, 61 aged <65 and 55 aged ≥65 years, who survived after a recent aSTEMI treated with pPCI, underwent dobutamine stress-echocardiography (DSE) and non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) during intravenous adenosine infusion. Baseline LV dimensions and systolic function were similar between the two groups; wall motion score indices during all DSE stages and CFR were also similar. In both groups, the LV ejection fraction was positively affected by the presence of viability in the necrosis area and by a higher CFR, but negatively influenced by viability in a remote area, an indirect sign of an extensive infarction size. This study demonstrates that PCI in the geriatric population with aSTEMI is as equally effective as in younger subjects, in terms of LV remodeling and function.

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References

  1. McGovern PG, Jacobs DR Jr, Shahar E, Arnett DK, Folsom AR, Blackburn H, Luepker RV (2001) Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota Heart Survey. Circulation 104:19–24

    Article  CAS  PubMed  Google Scholar 

  2. Acute myocardial infarction: pre-hospital, in-hospital management. The task force on the management of acute myocardial infarction of the European Society of Cardiology. Eur Heart J 17:43–63 (1996)

    Google Scholar 

  3. Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Garson A Jr, Gregoratos G, Smith SC Jr (1999) 1999 update: ACC/AHA Guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 100:1016–1030

    CAS  PubMed  Google Scholar 

  4. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr (2004) CC/AHA guidelines for the management of patients with ST-elevation myocardial infarction–executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 44:671–719

    Article  PubMed  Google Scholar 

  5. Barchielli A, Buiatti E, Balzi D, Santoro GM, Carrabba N, Fabiani P, Maci M, Margheri M, Mangani I, Monami M, Marchionni N (2004) Age-related changes in treatment strategies for acute myocardial infarction: a population-based study. J Am Geriatr Soc 52:1355–1360

    Article  PubMed  Google Scholar 

  6. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  7. Rathore SS, Mehta RH, Wang YF, Radford MJ, Krumholz HM (2003) Effects of age on the quality of care provided to older patients with acute myocardial infarction. Am J Med 114:307–315

    Article  PubMed  Google Scholar 

  8. Buonanno C, Variola A (2003) Le procedure di cardiologia interventistica negli anziani. L’impatto dello stent coronarico. Giornale di gerontologia 51:145–155

    Google Scholar 

  9. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED (2001) Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286:708–713

    Article  CAS  PubMed  Google Scholar 

  10. Kaehler J, Meinertz T, Hamm CW (2006) Coronary interventions in the elderly. Heart 92:1167–1171

    Article  PubMed  Google Scholar 

  11. Mehta RH, Granger CB, Alexander KP, Bossone E, White HD, Sketch MH (2005) Reperfusion strategies for acute myocardial infarction in the elderly—benefits and risks. J Am Coll Cardiol 45:471–478

    Article  PubMed  Google Scholar 

  12. Carlos ME, Smart SC, Wynsen JC, Sagar KB (1997) Dobutamine stress echocardiography for risk stratification after myocardial infarction. Circulation 95:1402–1410

    CAS  PubMed  Google Scholar 

  13. Smart S, Sagar K, Tresch D (2002) Age-related determinants of outcome after acute myocardial infarction: a dobutamine-atropine stress echocardiographic study. J Am Geriatr Soc 50:1176–1185

    Article  PubMed  Google Scholar 

  14. Bolognese L, Cerisano G, Buonamici P, Santini A, Santoro GM, Antoniucci D, Fazzini PF (1997) Influence of infarct-zone viability on left ventricular remodeling after acute myocardial infarction. Circulation 96:3353–3359

    CAS  PubMed  Google Scholar 

  15. Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, Homma S, Yoshida K, Yoshikawa J (2003) Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction. Heart 89:1163–1168

    Article  CAS  PubMed  Google Scholar 

  16. Kawamoto T, Yoshida K, Akasaka T, Hozumi T, Takagi T, Kaji S, Ueda Y (1999) Can coronary blood flow velocity pattern after primary percutaneous transluminal coronary angioplasty [correction of angiography] predict recovery of regional left ventricular function in patients with acute myocardial infarction? Circulation 100:339–345

    CAS  PubMed  Google Scholar 

  17. Ueno Y, Nakamura Y, Kinoshita M, Fujita T, Sakamoto T, Okamura H (2002) Can coronary flow velocity reserve determined by transthoracic Doppler echocardiography predict the recovery of regional left ventricular function in patients with acute myocardial infarction? Heart 88:137–141

    Article  CAS  PubMed  Google Scholar 

  18. Shiller NB, Shah PM, Crawford MH, DeMaria A, Devereux R, Feigenbaum H, Gutfesell H, Reichek N, Sahn D, Schnittger I, Silverman NH, Tajik AJ (1989) Recommendation for quantitation of left ventricle by two dimensional echocardiography. J Am Soc Echocardiogr 2:358–367

    Google Scholar 

  19. Smart SC, Sawada S, Ryan T, Segar D, Atherton L, Berkovitz K, Bourdillon PD, Feigenbaum H (1993) Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction. Circulation 88:405–415

    CAS  PubMed  Google Scholar 

  20. Savoye C, Equine O, Tricot O, Nugue O, Segrestin B, Sautiere K, Elkohen M, Pretorian EM, Taghipour K, Philias A, Aumegeat V, Decoulx E, Ennezat PV, Bauters C (2006) Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group). Am J Cardiol 98:1144–1149

    Article  PubMed  Google Scholar 

  21. Solomon SD, Anavekar N, Skali H, McMurray JJV, Swedberg K, Yusuf S, Granger CB, Michelson EL, Wang D, Pocock S, Pfeffer MA (2005) Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 112:3738–3744

    Article  PubMed  Google Scholar 

  22. Buiatti E, Barchielli A, Marchionni N, Balzi D, Carrabba N, Valente S, Olivotto I, Landini C, Filice M, Torri M, Regoli G, Santoro GM (2003) Determinants of treatment strategies and survival in acute myocardial infarction: a population-based study in the Florence district, Italy—results of the acute myocardial infarction Florence registry (AMI-Florence). Eur Heart J 24:1195–1203

    Article  PubMed  Google Scholar 

  23. Balzi D, Barchielli A, Santoro GM, Carrabba N, Buiatti E, Giglioli C, Valente S, Baldereschi G, Del BL, Monami M, Gensini GF, Marchionni N (2008) Management of acute myocardial infarction in the real world: a summary report from The Ami-Florence Italian Registry. Intern Emerg Med 3:109–115

    Article  PubMed  Google Scholar 

  24. Feldman LJ, Himbert D, Juliard JM, Karrillon GJ, Benamer H, Aubry P, Boudvillain O, Seknadji P, Faraggi M, Steg PG (2000) Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size. J Am Coll Cardiol 35:1162–1169

    Article  CAS  PubMed  Google Scholar 

  25. Lepper W, Hoffmann R, Kamp O, Franke A, de Cock CC, Kuhl HP, Sieswerda GT, Dahl J, Janssens U, Voci P, Visser CA, Hanrath P (2000) Assessment of myocardial reperfusion by intravenous myocardial contrast echocardiography and coronary flow reserve after primary percutaneous transluminal coronary angiography in patients with acute myocardial infarction. Circulation 101:2368–2374

    Google Scholar 

  26. Mazur W, Bitar JN, Lechin M, Grinstead WC, Khalil AA, Khan MM, Sekili S, Zoghbi WA, Raizner AE, Kleiman NS (1998) Coronary flow reserve may predict myocardial recovery after myocardial infarction in patients with TIMI grade 3 flow. Am Heart J 136:335–344

    Article  CAS  PubMed  Google Scholar 

  27. Bolognese L, Carrabba N, Parodi G, Santoro GM, Buonamici P, Cerisano G, Antoniucci D (2004) Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation 109:1121–1126

    Article  PubMed  Google Scholar 

  28. Bax M, de Winter RJ, Schotborgh CE, Koch KT, Meuwissen M, Voskuil M, Adams R, Mulder KJ, Tijssen JG, Piek JJ (2004) Short- and long-term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction. J Am Coll Cardiol 43:534–541

    Article  PubMed  Google Scholar 

  29. Garot P, Pascal O, Simon M, Monin JL, Teiger E, Garot J, Gueret P, Dubois-Rande JL (2003) Impact of microvascular integrity and local viability on left ventricular remodelling after reperfused acute myocardial infarction. Heart 89:393–397

    Article  CAS  PubMed  Google Scholar 

  30. Bolli R, Triana JF, Jeroudi MO (1990) Prolonged impairment of coronary vasodilation after reversible ischemia—evidence for microvascular stunning. Circ Res 67:332–343

    CAS  PubMed  Google Scholar 

  31. Nohtomi Y, Takeuchi M, Nagasawa K, Arimura K, Miyata K, Kuwata K, Yamawaki T, Kondo S, Yamada A, Okamatsu S (2003) Persistence of systolic coronary flow reversal predicts irreversible dysfunction after reperfused anterior myocardial infarction. Heart 89:382–388

    Article  CAS  PubMed  Google Scholar 

  32. Rochitte CE, Lima JA, Bluemke DA, Reeder SB, McVeigh ER, Furuta T, Becker LC, Melin JA (1998) Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 98:1006–1014

    CAS  PubMed  Google Scholar 

  33. Lombardo A, Loperfido F, Trani C, Pennestri F, Rossi E, Giordano A, Possati G, Maseri A (1997) Contractile reserve of dysfunctional myocardium after revascularization: a dobutamine stress echocardiography study. J Am Coll Cardiol 30:633–640

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Adriana Bambi, RN; Maddalena Ciompi, RN; and Marzia Conforti, RN; for their assistance during echocardiographic examination.

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Correspondence to Francesca Innocenti.

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Innocenti, F., Caldi, F., Meini, C. et al. Left ventricular remodeling in the elderly with acute anterior myocardial infarction treated with primary coronary intervention. Intern Emerg Med 5, 311–319 (2010). https://doi.org/10.1007/s11739-010-0425-2

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  • DOI: https://doi.org/10.1007/s11739-010-0425-2

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