Early Predictors of Left Ventricular Remodeling after Primary Percutaneous Coronary Intervention

Abstract
Background: Successful primary Percutaneous Coronary Intervention (PCI), has reduced the mortality of patients with Acute Myocardial Infarction (AMI). However, the increased survival rate resulted in the increased incidence of Left Ventricular (LV) remodeling. Ventricular remodeling is a predictor of heart failure and for this reason it assumes a negative prognostic value.
Aim of the Study: Was to assess the percentage of LV remodeling and to identify at discharge early predictors of LV remodeling after primary PCI.
Material and Methods: We included 152 patients diag-nosed as acute STEMI and underwent successful primary PCI. All patients were examined by transthoracic echocardi-ography at discharge and 6 months later. LV remodeling defined as increase in Left Ventricular End Diastolic Volume Index (LVEDVI) >20%. Patients were grouped into two groups: Group I (with LV remodeling) and Group II (without LV remodeling). The following factors affecting LV remodeling were evaluated: Infarct Related Artery (IRA), number of vessels affected, use of thrombus aspiration, type of stent used, post PCI TIMI flow, time to reperfusion, Wall Motion Score Index (WMSI) and cardiovascular risk factors.
Results: Patients with an increase in LVEDVI >20% who were considered to have LV remodeling (Group I) were 49 patients (32.2%). Anterior MI was significantly more in Group
I patients (89.8%) vs. (44.7%) in Group II patients (p-value= 0.00). Left Anterior Descending (LAD) artery affection was significantly more in Group I (89.8%) vs. (45.6%) in Group
II (p-value=0.00). Ejection fraction noticed to be significantly greater at baseline in Group II (51±6.81%) vs. (41.4±6.59%) in Group I (p-value=0.00) while Group I patients had signif-icant higher WMSI (1.66±0.19) vs. (1.28±0.17) in Group II (p-value=0.00).
Conclusions: LV remodeling occurred in 32.2% of patients. Patients with ECG diagnosis as (anterior MI), WMSI (>1.5), ejection fraction (£45%), and LAD as an IRA were at higher risk for LV remodeling (p<0.05). WMSI (>1.5) and LAD as an IRA were the only independent predictors for LV remodeling after primary PCI (relative risk; 3.2 and 2.6 respectively).