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Minerva Cardiology and Angiology 2021 April;69(2):144-53

DOI: 10.23736/S2724-5683.20.05176-2


lingua: Inglese

Impact of drug-eluting stents on left ventricular wall motion after successful reperfusion of first anterior ST elevation myocardial infarction

Plinio CIRILLO, Raffaele IZZO, Costantino MANCUSI, Francesco BUONO, Francesca ZIVIELLO, Letizia SPINELLI, Giovanni ESPOSITO, Giuseppe DI GIOIA, Emanuele BARBATO, Teresa STRISCIUGLIO, Bruno TRIMARCO, Carmine MORISCO

Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

BACKGROUND: Timely myocardial reperfusion by primary percutaneous coronary intervention (pPCI) prevents the development of left ventricular (LV) dysfunction after myocardial infarction (MI). We aimed to investigate whether bare-metal stents (BMS) and drug eluting stents (DES) differently affect the recovery of LV function in patients with ST-elevation MI (STEMI).
METHODS: Overall 103anterior STEMI patients were retrospectively analyzed. All patients had single vessel disease with culprit lesion at the left anterior descending coronary artery. Patients were categorized in DES group (N.=67) and BMS group (N.=36). Changes in LV contractility were assessed by trans-thoracic echocardiogram as Left Ventricular Wall Motion Score Index (LVWMSI). Follow-up visits were performed between 6 and 12 months after hospital discharge.
RESULTS: Compared to baseline, LV ejection fraction (EF) remained unchanged between the two groups at the follow-up; LVWMSI significantly improved in patients treated with DES (1.95±0.25 vs. 1.78±0.38, P<0.05), whereas did not change in those treated with BMS (2.09±0.21 vs. 1.98±0.33, P: not significant). At follow-up the LVWMSI was significantly higher in patients with DES than with BMS (P=0.048). LV end-systolic and end-diastolic volumes (LVESV, LVEDV) significantly increased in patients receiving a BMS, whereas it did not change in those receiving a DES (P<0.05). Multivariate analysis adjusted for age, gender, type of stent (DES or BMS), and type of revascularization (primary PCI or rescue PCI or thrombolysis + PCI) showed that DES implantation was an independent predictor of LVWMSI improvement (OR: 3.8 [1.143-12.969] P=0.03).
CONCLUSIONS: DES implantation is associated with a favorable impact on LV remodeling and regional contractility.

KEY WORDS: Ventricular remodeling; Ventricular function, left; Percutaneous coronary intervention; Echocardiography

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