940-75 Effect of Coronary Revascularization on Left Ventricular Remodeling in Patients Receiving Thrombolytic Therapy for Myocardial Infarction: A One Year Follow-up

Remodeling starts in the acute phase of myocardial infarction by infarct formation and expansion. Thrombolytic therapy in the acute phase may affect infarct formation. Whether coronary revascularization (CR) in the subacute or chronic phase may add to the prevention of dilatation is not known. In a post-hoc analysis, we investigated the effect of coronary angioplasty (PTCA) and coronary bypass surgery (CABG) on left ventricular volume assessed by serial echocardiography during a one year follow-up.In the Captopril And Thrombolysis Study, 298 patients (age: 59±10) with first anterior myocardial infarction treated with IV streptokinase were randomized to either oral captopril or placebo. Left ventricular end-diastolic and end-systolic volume index (LVEDVI and LVESVI) were assessed by 2D echocardiography within 24 hours, at day 3 and 10, after three months and after one year. Ninety-nine patients underwent CR by PTCA (n=76) or CABG (n=23) on clinical indication at 34 days (range 1 to 293) after onset of symptoms. Baseline characteristics of CR patients were comparable to those of patients not receiving active revascularization (NCR). During the follow-up NCR patients, as contrasted to CR-patients, showed a gradual increase in LVEDVI of9ml/m2(95%CI; 5–13). Dilatation (defined as LVEDVI>64 and/or LVESVI >29 ml/m2) occurred more frequently in the NCR-group (47% vs 29%, P=0.0004).ConclusionCoronary revascularization in addition to thrombolytic therapy may further reduce the risk for ventricular dilatation during the first year after myocardial infarction