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2報) : 経皮的冠動脈形成術の再施行と運動耐容能

Abstract

There are no formal guidelines for repeating coronary intervention in asymptomatic 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 evaluate the effect of repeated PTCA on exercise tolerance in 22 patients who had undergone PTCA in the acute phase of AMI and subse- quently developed restenosis in the chronic phase. Of the 22 patients, 11 patients (group S) underwent repeated PTCA for a single-vessel-restenosis ; 5 patients (group M1) under- went repeated PTCA for an infarct-related artery restenosis, but were not treated for a residual stenosis; and 6 patients (group M2) underwent tepeated PTCA for a residual stenosis, but were not treated for an infarct-related artery restenosis observed at the coronary angiography 6 months after AMI. Exercise tolerance was estimated using a cardiopulmonary exercise test with ventilatory gas analysis before and after repeated PTCA 6 months after AMI. Repeated PTCA significantly improved exercise tolerance and the pressure rate product at peak exercise within 1 week of intervention in groups M1 and M2, but had no significant effect in group S. Therefore, repeated PTCA should be perfor- med in patients with severe coronary artery disease, because cardiac function is the main determinant of exercise tolerance in patients with severe myocardial ischemia.