Clinical and Coronary Angiographic Predictors of Left Ventricular Remodeling 6 Months After First Anterior STEMI in Patients Managed By Primary PCI

Abstract

STEMI is the most serious presentation of atherosclerotic CAD and it is known for its effect on cardiac function and can lead to impaired segmental and even global myocardial function. The benefits of primary PCI have been ascribed to achievement of early superior flow with significant larger myocardial salvage and improved survival compared with thrombolysis. LV remodeling after AMI is a precursor of the development of overt heart failure and is an important predictor of mortality. Patients with acute anterior MI experience more pronounced adverse LV remodeling and, thereby, have worse prognosis than non-anterior MI patients. HF secondary to MI remains major source of morbidity and mortality. Long-term outcome after MI can be largely defined in terms of its impact on the size and shape of the LV. Three major mechanisms contribute to LV remodeling which are early infarct expansion, subsequent infarct extension into adjacent non-infarcted myocardium, and late hypertrophy in the remote LV. Future developments in preventing post-MI HF will depend not only on identifying drugs targeting LV remodeling mechanisms, but also on diagnostic techniques capable of early prediction of LV remodeling. This study was conducted on 81 patients who presented to the cardiology department of Ain Shams university hospital, with first acute anterior STEMI and underwent primary PCI to LAD artery. Patients admitted to the coronary care unit were analyzed thoroughly and data was recorded {Full history taking, clinical examination, 12 lead surface ECG, CK total and CK-MB, coronary angiographic details and transthoracic echocardiography in the first 48 hours}.