陳旧性心筋梗塞患者の運動耐容能に及ぼす心筋虚血の影響(第1報) : 経皮的冠動脈形成術後再狭窄と運動耐容能

Abstract

There has been controversy regarding treatment in patients with coronary restenosis who have undergone primary percutaneous transluminal coronary angioplasty (PTCA) in the setting of acute myocardial infarction (AMI). The purpose of this study was to investigate the relationship between coronary restenosis and exercise tolerance in 53 patients who had undergone PTCA in the acute phase of AMI. Of the 53 patients, 28 patients (group N) had no restenosis, 19 patients (group S1) had a single-vessel-restenosis, and 6 patients (group S2) had a restenosis and a residual stenosis without PTCA at the coronary angiography 6 months after AMI. Exercise tolerance was estimated using a cardiopulmonary exercise test with ventilatory gas analysis at 1 and 6 months after AMI. The improvement in exercise tolerance from 1 month to 6 months after AMI was significant in group N, but not in group S1. Exercise tolerance tended to decrease in group S2. The stroke index on exercise up to 20 W at 6 months after AMI increased significantly in groups N and S1, but not in group S2. Coronary restenosis in the chronic phase of AMI may decrease exercise tolerance in patients with a history of PTCA in acute-phase AMI because cardiac function is limited by severe myocardial ischemia. These results suggest that repeated PTCA would improve exercise tolerance in patients with multiple-vessel stenosis.