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| Left Ventricular Functional Improvement Associated with Platelet Glyocoprotein IIbIIIa Inhibitor in Patients Underwent Early Primary Percutaneous Coronary Intervention with ST Elevation Myocardial Infarction |
| 전남대학교병원 심장센터, 보건복지부 심장질환 특성화 연구센터 |
| 고점석, 정명호, 김현국, 이민구, 박근호, 심두선, 윤남식, 윤현주, 박형욱, 홍영준, 김주한, 안영근, 조정관, 박종춘, 강정채, 박옥규 |
Introduction: Platelet glyocoprotein IIbIIIa (GpIIbIIIa) inhibitor was known as potent anti-platelet agent and a number of randomize trials demonstrated it’s clinical benefit in treatment of acute myocardial infarction. We aimed to clarify whether administration of GpIIbIIIa inhibitor along with primary PCI was associated with improvement of LV function in patients with ST elevation myocardial infarction (STEMI).
Methods: 386 patients (male 78%, 60±12 years) with STEMI who had severe LV dysfunction (EF<40%) in initial echocardiography were enrolled. All of patients underwent successful PCI (achieved TIMI III flow without complication) within 6 hours from onset of symptom. We checked baseline clinical characteristics, laboratory findings and angiographic data. Serial echocardiographic exams were performed at baseline and 1 month follow-up. Predictors of improvement of LV systolic function and the incidence for major advance cardiac events (MACE) at 1 year were analyzed.
Results: Mean baseline EF was 41±6.9%. Improvement of LV function defined as more than 10% increment of LV ejection fraction was observed in 119 patients (30.8%). Patients with GpIIbIIIa inhibitor infusion had higher incidence of LV functional improvement (43.2% vs. 29.2%, p=0.04). Peak CK-MB level(215.9±269.8 vs. 294.4±321.7, p=0.02) and peak troponin I level(50.9±59.2 vs. 77.3±91.0) was lower in LV functional improvement group. There was no significant difference in other clinical, laboratory, angiographic finings including incidence of distal protection device between two groups. After multivariate analysis by logistic regression test, administration of GpIIbIIIa inhibitor remained independent predictor of LV functional improvement (OR=1.98, p=0.045). In survival analysis, improvement of LV function was associated of lower incidence of death/myocardial infarction (HR=0.38, p=0.038)
Conclusion: Administration of GpIIbIIIa inhibitor was independent predictor of LV functional improvement in STEMI patients with severe LV dysfunction and underwent primary PCI.
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