Influence of time elapsed from the onset of chest pain to revascularization on left ventricular ejection fraction in patients with acute anterior st elevation myocardial infarction


Aistė Šalkauskaitė1, Kasparas Rubliauskas1, Rytis Mickus1, Giedrė Stanaitienė2 

1 Faculty of Medicine, Academy of Medicine, Lithuanian University of Health Sciences

2 Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences,

Kaunas, Lithuania


Introduction: acute myocardial infarction (MI) with elevation of ST segment remains one of the leading causes of mortality worldwide. Many studies proved percutanious transluminal coronary artery angioplasty (PTCAA) to improve the function of left ventricle (LV) and reduce the following myocardial dilatation and remodelling in patients with acute MI. However, in clinical practice many patients delay seeking for help – as a result myocardium becomes greatly damaged.

Aim of the study: to evaluate the influence of time from the onset of MI symptoms to revascularization, age and number of damaged coronary arteries (CA) on early remodelling of the myocardium.

Methods: we performed a retrospective study of patients with first-ever anterior acute MI with ST segment elevation who underwent a successful PTCAA and stenting procedure. Age, cardiovascular risk factors, number and location of damaged CA, precise time of the onset of chest pain, CA revaskularization and stenting were estimated. Echocardiographic early LV ejection fraction (EF) was evaluated post-revasculatization and stenting as a  manifestation of early remodelling of myocardium.

Results: mean age of 204 analyzed patients was 63,9 ± 13,3 years (y.): 62,1 ± 0,9 y. for males, 73.5 ± 1,5 y. for females. Overall duration of mean time from the onset of chest pain to revascularization was 1437,7 ± 197,02 minutes (min.). Overall mean LV EF was 38,6 ± 7,9 percent (pct.). LV EF did not differ significantly between patients with <12 hours (h.) and >12 h. time duration from the onset of MI symptoms to PTCAA and CA stenting (p=0,117). A significant corellation between age bellow 60 y. and greater LV EF: 40,9 ± 7,7 pct. – was noted when compared to the LV EF: 38,4 ± 8,6 pct. – in patients over 60 y. of age (p=0,033). LV EF was also significantly lower in patients diagnosed with damage of more than a single CA  (p=0,0009).

Conclusons: the duration of time from the onset of chest pain to PTCAA and stenting did not impact the early LV EF in patients with first-ever acute anterior MI with ST segment elevation. However, early LV EF after acute MI was significanly greater in patients bellow 60 y. of age and in patients diagnosed with damage of a single CA.

Key words: acute myocardial infarction, chest pain, left ventricular ejection fraction, remodelling.