Coronary Recanalization By Elective Angioplasty Prevents Ventricular Dilation After Anterior Myocardial Infarction

In the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that a fully reperfused infarct related artery benefits healing post AMI.The study has included 40 patients with uncomplicated first acute anterior STEMI (27 males and 13 females), that was successfuly thrombolysed with age range of 41-71 years and mean age was 55.6 years. All patients were subjected to:• Echocardiography to estimate LVESV index, LVEDV index, EF on admission, after 3 months and after 6 months.• Coronary angiography to all patients that showed LAD lesion (single, significant lesion) and PCI to LAD in group II only during the first month post STEMI.Patients were divided into 2 groups :Group (1): This group is the medical therapy group. This group included 20 patients (10 males and 10 females). Their mean age was 52.9±8.7 years.Group (2): This group is the PCI plus optimal medical therapy group. This group included 20 patients (12 males and 8 females). Their mean age was 49.8±7.8 years.Late intervention within 1 month post AMI resulted in significantly improved LV end-systolic volume indexes at 6 months than medical therapy alone (30.17± 6.61 mL/m2 VS 37.52±9.76 mL/m2, p<0.05). Left ventricular end-diastolic volume indexes had no statistically significant difference between two groups (70.05±14.91 mL/m2 versus 66.15±11.15 mL/m2, p>o.o5). In the PCI group, mean change of EDV index on admission and at 6 months was significantly reduced (-3.84±3.98 mL/m2). LVEF was significantly greater in the PCI group than in the medical group after 6 months (46.66±6.19% versus 54.56±4.24%, p<0.05).In the present study, we found that PCI to LAD post successful thrombolysis in symptom-free patients within 1 month post AMI had a better effect on remodeling compared to medical therapy only.Recommendations :• Further research with larger calibre studies is recommended to prove evidence base for routine coronary angiography and PCI post successful thrombolysis for patients with antrior STEMI and significant single vessel disease (LAD) in the subacute phase of MI.• Further research is also recommended targeting clinical primary end points as death, reinfarction and hospitalization due to ACS or heart failure to compare these end points in the invasive versus non invasive approach of management post successfully thrombolysed anterior STEMI in patients with single LAD lesion.• Further research targeting other coronary vessels as culprit arteries (e.g: RCA, LCX) is recommended.• Longer follow up of patients should be considered in the future studies.• Peri-procedural complications, patients’ compliance which can affect left ventricular remodeling should be considered in future research..