Predictors of Left Ventricular Dysfunction in Patients with First Acute Anterior Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract
Background: LV dysfunction after acute MI is the most important factor affecting morbidity and mortality. Any effort should be made to minimize it.
Aim of the Study: To evaluate the effect of clinical and angiographic variables on LV systolic function in patients with first acute anterior MI undergoing primary PCI.
Patients and Methods: A prospective observational study conducted from October 2016 to June 2017, at the Cardiovas-cular Medicine Department, Tanta University Hospitals in Gharbia Governorate, Egypt. The study enrolled 100 consec-utive adult patients of both genders who were diagnosed with definite first acute anterior MI within 12 hours from the time of symptoms onset and were treated by primary PCI. Clinical and angiographic data were collected prospectively. Clinical outcome (death, major cardiovascular event) were evaluated during hospitalization. Patients were divided into three groups by degree of LV dysfunction, normal-mild (EF >50%), mod-erate (EF=40-50%) and severe (EF <40%) and compared for clinical, angiographic and procedural variables.
Results: On statistical analysis between studied groups, the principal finding of this study was that depressed LV function in patients with first acute anterior MI was associated with longer time to door (r=0.560, p=<0.001) and door to balloon (r=0.378, p=<0.001) times, higher CKMB level (r=0.565, p=<0.001), renal impairment defined as creatinine clearance <60mL/min (p=0.013), peripheral vascular disease (p=0.013), low TIMI flow grade before and after angioplasty (r=0.347, p=<0.001), low myocardial blush grade (r=0.347, p=<0.001). Regarding in-hospital mortality and major cardi-ovascular events defined as recurrent myocardial infarction, repeat coronary revascularization of the target lesion, and heart failure, was higher in Group III.
Conclusion: Degree of LV dysfunction following first acute anterior MI can be identified by clinical and angiographic variables that are readily available at the time of initial assessment. The principal finding of this study is that abnormal LV systolic function after first acute anterior MI can be predicted by longer door to balloon time and larger infarction size as assessed by CKMB levels. Renal impairment, peripheral vascular disease, multi-vessel disease and low TIMI flow grade before and after angioplasty are associated with depressed LV function in patients with first acute anterior MI.