engleski

Primary Percutaneuos Coronary Intervention vs. Fibrinolysis in Acute Myocardial Infarction: Implications on the Patients' Postinfarction Functional Capacity and the Level of Autonomic Dysbalance

Aim: The aim of this study was to investigate the influence of treatment strategy in acute phase of MI on functional capacity and level of autonomic dysbalance after acute phase of disease. Methods: This prospective study included 128 consecutive patients who had MI with ST- elevation less than 12 weeks of onset of disease during stationary rehabilitation treatment. There were 71% male and 29% female patients (mean age of pts were 58 &plusmn ; 10 year). The patients were divided into three groups: group I with 38 pts (30%) &#8211; pts who were treated with primary PCI, group II with 46 pts (36%) &#8211; pts who received fibrinolysis and group III with 44 pts (34%) &#8211; pts who were treated conservatively. The functional capacity and level of autonomic dysbalance of the patients were evaluated by symptom-limited exercise test and analysis of heart rate variability (HRV), respectively. The echocardiographic exams were also done in each patient. Results: At the end of rehabilitation, mean value of exercise capacity in the group I were 6.1 &plusmn ; 1.3, group II 5.5 &plusmn ; 1.2 and group III 4.8 &plusmn ; 1.3 METs, respectively (group I vs. II p=0.03 ; group I vs. III, p<0.001 ; group II vs. III, p=0.01). Mean value of ejection fraction in the group I were 56 &plusmn ; 10, group II 53 &plusmn ; 9 and group III 47 &plusmn ; 11% (group I vs. II p=0.03 ; group I vs. III p<0.001 ; group II vs. III p=0.009). Furthermore, mean value of SDNN in the group I were 124 &plusmn ; 21 ms, group II 109 &plusmn ; ; 27 ms and group III 95 &plusmn ; 26 ms, respectively (group I vs. II, p=0.008 ; group I vs. III, p<0.001 ; group II vs. III, p=0.01). Conclusions: Patients who underwent PCI in acute phase of MI have higher postinfarction functional capacity, better preserved systolic function of left ventricle and lower level of autonomic dysbalance in comparison with patients who received fibrinolysis or those who were treated conservatively.

heart rate; angioplasty; fibrinolysis; autonomic nervous system

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