Abstract 3745: Asymmetric Dimethylarginine and Mortality after Acute Myocardial Infarction

Background . From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyse the predictive value of ADMA concentrations on mortality at 1 year follow-up. ADMA is an endogenous competitive inhibitor of NO synthases. Patients . Blood samples from 204 consecutive patients hospitalised for acute MI < 24 hr were taken on admission. Serum levels of ADMA, its stereoisomer, symmetric dimethylarginine (SDMA), were determined using high-performance liquid chromatography and fluorescence. Results . The mean (SD) ADMA level was 1.07(0.37) μmol/L. ADMA was positively related to age, homocysteine, SDMA and L-arginine. The glomerular filtration rate (GFR) showed a trend toward an inverse relation with ADMA. ADMA concentrations showed a trend towards a higher level in women than in men (p=.101) and were lower in current smokers vs past or non smokers (p=0.022). Baseline ADMA and SDMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (respectively 1.22(1.06–1.54) vs 0.98(0.78–1.24), p=0.012 and 0.77(0.54–1.03) vs 0.47(0.35–0.64), p<0.001). By Cox stepwise multivariate analysis, high levels of ADMA were one of the strongest predictors for mortality (HR(95%CI), 6.63(2.55–17.21)), even when adjusted for potential confounders, such as biological and clinical factors, and reperfusion. In contrast, SDMA failed to independently predict the outcome (HR(95%CI): 1.88(0.33–10.70). Conclusion . Our study suggests that measurement of ADMA levels at baseline improves cardiovascular risk prediction after acute MI, beyond traditional risk factors and biomarkers. ADMA may thus constitute a novel and useful marker for risk stratification in acute MI.

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P1755Plasma proteomics in healthy individuals predict myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0508 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Hoogeveen ◽

J P Belo Pereira ◽

V Zampoleri ◽

M J Bom ◽

W Koenig ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plasma Proteins ◽

Risk Model ◽

Machine Learning Algorithms ◽

Machine Learning Techniques ◽

Traditional Risk Factors

Abstract Background Currently used models to predict cardiovascular event risk have limited value. It has been shown repetitively that the addition of single biomarkers has modest impact. Recently we observed that a model consisting of a larger array of plasma proteins performed very well in predicting the presence of vulnerable plaques in primary prevention patients. However, the validation of this protein panel in predicting cardiovascular outcomes remains to be established. Purpose This study investigated the ability of a 384 preselected protein biomarkers to predict acute myocardial infarction, using state-of-the-art machine learning techniques. Secondly, we compared the performance of this multi-protein risk model to traditional risk engines. Methods We selected 822 subjects from the EPIC-Norfolk prospective cohort study, of whom 411 suffered a myocardial infarction during follow-up (median 15 years) compared to 411 controls who remained event-free (median follow-up 20 years). The 384 proteins were measured using proximity extension assay technology. Machine learning algorithms (random forests) were used for the prediction of acute myocardial infarction (ICD code I21–22). Performance of the model was tested against and on top of traditional risk factors for cardiovascular disease (refit Framingham). All performance measurements were averaged over several stability selection routines. Results Prediction of myocardial infarction using a machine-learning model consisting of 50 plasma proteins resulted in a ROC AUC of 0.74±0.14, in comparison to 0.69±0.17 using traditional risk factors (refit Framingham. Combining the proteins and refit Framingham resulted in a ROC AUC of 0.74±0.15. Focussing on events occurring within 3 years after baseline blood withdrawal, the ROC AUC increased to 0.80±0.09 using 50 plasma proteins, as opposed to 0.67±0.22 using refit Framingham (figure). Combining the protein model with refit Framingham resulted in a ROC AUC of 0.82±0.11 for these events. Diagnostic performance events <3yrs Conclusion High-throughput proteomics outperforms traditional risk factors in prediction of acute myocardial infarction. Prediction of myocardial infarction occurring within 3 years after inclusion showed highest performance. Availability of affordable proteomic approaches and developed machine learning pave the path for clinical implementation of these models in cardiovascular risk prediction. Acknowledgement/Funding This study was funded by an ERA-CVD grant (JTC2017) and EU Horizon 2020 grant (REPROGRAM, 667837)

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The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620943295 ◽

2020 ◽

Vol 26 ◽

pp. 107602962094329

Author(s):

Xiang Wang ◽

Meng Guan ◽

Xiuhang Zhang ◽

Taiyuan Ma ◽

Muli Wu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stent Thrombosis ◽

High Sensitivity ◽

Coronary Intervention ◽

Serum Levels ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Hs Crp

Very late stent thrombosis (VLST) is a rare but serious complication following percutaneous coronary intervention (PCI). S100A8/A9 plays an important role in thrombosis through modulating the inflammatory response. This observational study aimed to reveal the association between S100A8/A9 and VLST. Continuous blood samples were collected from patients at both the time of index PCI for acute myocardial infarction (AMI) and the time of PCI for VLST (VLST group) or follow-up coronary angiography (AMI group). In all, 56 patients were selected in each group from a cohort of 8476 patients and other 112 individuals who underwent health checkups (normal control [NC] group) were selected as controls. Serum levels of S100A8/A9 and high sensitivity C-reactive protein (hs-CRP) were tested and compared. The mean level of S100A8/A9 was 3754.4 ± 1688.9 ng/mL during index PCI and increased to 5517.8 ± 2650.9 ng/mL at the time of VLST; in the AMI group, S100A8/A9 level was 2434.9 ± 1243.4 ng/mL during index PCI and decreased to 1568.2 ± 772.1 ng/mL during follow-up, similar to that detected in the NC group (1618.2 ± 641.4 ng/mL). Of note, S100A8/A9 levels showed significant increases during VLST when compared to its own levels during index PCI, which was different from the changes of hs-CRP. Higher serum levels of S100A8/A9 are associated with the development of VLST.

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Routine Oxygen Therapy Does Not Improve Health-Related Quality of Life in Patients With Acute Myocardial Infarction—Insights From the Randomized DETO2X-AMI Trial

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.638829 ◽

2021 ◽

Vol 8 ◽

Author(s):

Robin Hofmann ◽

Tamrat Befekadu Abebe ◽

Johan Herlitz ◽

Stefan K. James ◽

David Erlinge ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Oxygen Therapy ◽

Ambient Air ◽

Related Quality ◽

Health Related ◽

Acute Mi

Background: After decades of ubiquitous oxygen therapy in all patients with acute myocardial infarction (MI), recent guidelines are more restrictive based on lack of efficacy in contemporary trials evaluating hard clinical outcomes in patients without hypoxemia at baseline. However, no evidence regarding treatment effects on health-related quality of life (HRQoL) exists. In this study, we investigated the impact of routine oxygen supplementation on HRQoL 6–8 weeks after hospitalization with acute MI. Secondary objectives included analyses of MI subtypes, further adjustment for infarct size, and oxygen saturation at baseline and 1-year follow-up.Methods: In the DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 L/min for 6–12 h or ambient air. In this prespecified analysis, patients younger than 75 years of age with confirmed MI who had available HRQoL data by European Quality of Life Five Dimensions questionnaire (EQ-5D) in the national registry were included. Primary endpoint was the EQ-5D index assessed by multivariate linear regression at 6–10 weeks after MI occurrence.Results: A total of 3,086 patients (median age 64, 22% female) were eligible, 1,518 allocated to oxygen and 1,568 to ambient air. We found no statistically significant effect of oxygen therapy on EQ-5D index (−0.01; 95% CI: −0.03–0.01; p = 0.23) or EQ-VAS score (−0.57; 95% CI: −1.88–0.75; p = 0.40) compared to ambient air after 6–10 weeks. Furthermore, no significant difference was observed between the treatment groups in EQ-5D dimensions. Results remained consistent across MI subtypes and at 1-year follow-up, including further adjustment for infarct size or oxygen saturation at baseline.Conclusions: Routine oxygen therapy provided to normoxemic patients with acute MI did not improve HRQoL up to 1 year after MI occurrence.Clinical Trial Registration:ClinicalTrials.gov number, NCT01787110.

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ACUTE MYOCARDIAL INFARCTION;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.02.2072 ◽

2018 ◽

Vol 21 (02) ◽

pp. 258-263

Author(s):

Mukhtiar Hussain Jaffery ◽

Khalida Shaikh ◽

Ghulam Hussain Baloch ◽

Syed Zulfiquar Ali Shah

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Serum Magnesium ◽

Diabetic Patients ◽

Inferior Wall ◽

Female Population ◽

Male And Female ◽

Case Series Study ◽

Acute Mi ◽

The Mean

Objective: This descriptive case series study evaluates the frequency ofhypomagnesemia in patients with acute myocardial infarction. Patients and methods: Thismultidisciplinary conducted at Liaquat University Hospital Hyderabad and a private hospitalHyderabad from May 2010 to October 2010. All patients diagnosed as acute myocardialinfarction were further evaluated for type of myocardial infarction and serum magnesium level.Results: Out of 100 diabetic patients, 77 were males and 23 patients were females. The meanage and standard deviation of patients of male and female was 54.78 ± 8.82 (SD) and 53.64 ±10.82 (SD), respectively. The mean ± SD for serum magnesium in overall subjects was 1.24±0.48. Regarding the type of AMI inferior wall in 22 (29%), lateral wall in 17 (22%), anteroseptal in12 (16%), anterolateral -V1 in 07(09%), right ventricular in 10 (13%) and posterior wall in 07 (09%).The mean duration of acute MI in male and female population was 8.71±6.73 hours and17.70±14.57 hours (p<0.01) where as the mean duration of acute MI in hypomagnesemic andnormomagnesemic patient was 5.16±2.49 hours and 26.60±8.27 (p = 0.02) respectively. Themean serum magnesium level in male as well as female population was 1.32 ±0.21 mg/dl and1.46± 0.53 mg/dl p = 0.05, respectively. Regarding the hypomagnesemia in male and femalepopulation was 34(75.6%) and 16(53.3%) p=0.04, respectively. The hypomagnesemia was morepredominant in inferior 18(36.0%) and lateral 16 (32.0%) wall MI. Conclusions: Thehypomagnesemia was observed in patients with acute myocardial infarction with statisticalsignificance

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Short and Midterm Outcomes in Patients With Acute Myocardial Infarction: Results of the Nationwide TURKMI Registry

Angiology ◽

10.1177/0003319720975302 ◽

2020 ◽

pp. 000331972097530

Author(s):

Mustafa Kilickap ◽

Mustafa Kemal Erol ◽

Meral Kayikcioglu ◽

Ibrahim Kocayigit ◽

Mesut Gitmez ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Coronary Intervention ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary ◽

Acute Mi

This recent Turkish Myocardial Infarction registry reported that guidelines are largely implemented in patients with acute myocardial infarction (MI) in Turkey. We aimed to obtain up-to-date information for short- and midterm outcomes of acute MI. Fifty centers were selected using probability sampling, and all consecutive patients with acute MI admitted to these centers (between November 1 and 16, 2018) were enrolled. Among 1930 (mean age 62 ± 13 years, 26% female) patients, 1195 (62%) had non-ST segment elevation myocardial infarction (NSTEMI) and 735 (38%) had ST segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) was performed in 94.4% of patients with STEMI and 60.2% of those with NSTEMI. Periprocedural mortality occurred in 4 (0.3%) patients. In-hospital mortality was significantly higher in STEMI than in patients with NSTEMI (5.4% vs 2.9%, respectively; P = .006). However, the risk became slightly higher in the NSTEMI group at 1 year. Women with STEMI had a significantly higher in-hospital mortality compared with men (11.2% vs 3.8%; P < .001); this persisted at follow-up. In conclusion, PCI is performed in Turkey with a low risk of complications in patients with acute MI. Compared with a previous registry, in-hospital mortality decreased by 50% within 20 years; however, the risk remains too high for women with STEMI.

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Quality of Life after Coronary Revascularization in Patients with Acute Myocardial Infarction

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0011 ◽

2016 ◽

Vol 1 (1) ◽

pp. 51-54

Author(s):

Mihaela Susca ◽

Monica Copotoiu ◽

Horaţiu Popoviciu ◽

Zsuzsanna Szőke ◽

Balázs Bajka ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Revascularization ◽

Self Care ◽

Female Group ◽

Limited Mobility ◽

Acute Mi

Abstract Background: The quality of life (QoL) in acute myocardial infarction (MI) patients can be improved using 3 therapeutic methods — surgical, pharmaceutical and physical. Study aim: We sought to assess the QoL in patients following an acute MI, with or without percutanous coronary intervention (PCI). Material and methods: A number of 54 patients with acute MI were included in the study. All subjects were asked to complete the EQ-SD questionnaire at baseline, and during the 12-month follow-up. The questionnaire consists of 2 parts: 1st part – assesses the mobility, self care, activities of daily life (ADL), pain, depression and anxiety; 2nd part – visual analogue scale (VAS) for the overall state. Patients were divided into 4 groups: Group 1 – all patients (n = 54); Group 2 – males (n = 40), Group 3 – female patients (n = 14), and Group 4 – patients who underwent a PCI procedure (n = 48). Blood pressure (BP) was also monitored. Results: The mean age was 66.54 years. There were no differences between the groups at baseline, and after 1 year regarding the BP. No differences were observed regarding the VAS (baseline p = 0.990; 12-month p = 0.991). Concerning the PCI vs. non-PCI groups, no differences were found in relation to mobility, self-care, ADL, pain and depression at baseline or after 12 months. For all groups at baseline, the limited mobility was positively correlated with impaired self-care (p = 0.041) and lower ADLs (p = 0.003). After 1 year, a limited mobility was associated with defective self-care (p <0.001) and decreased ADLs (p = 0.004) and there was an improvement in mobility (p = 0.0002) and self-care (p <0.0001), compared to baseline. The PCI group associated pain with depression at baseline (p <0.001) and limited mobility with lack of ADLs (p = 0.005). At 12 months, we observed an improvement in mobility, self-care (p <0.001), and the ADLs (p <0.001). The males showed a positive association between depression and pain (p <0.001) at baseline, but not after 1 year. Mobility was the only parameter that had improved during follow-up (p = 0.043). In the female group, pain (p = 0.015) and mobility (p = 0.033) had improved after 12 months. Conclusions: The QoL had improved in terms of mobility, self-care and new skills acquired after PCI. Both depression and pain were ameliorated in the male group, despite the lack of improvement on VAS for the overall state.

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Rates Of Fibrin Growth As A Predictor Of Acute Myocardial Infarction. A Prospective Blind Study

10.1055/s-0038-1652770 ◽

1981 ◽

Author(s):

D Joe Baughman ◽

J B Kostis

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Ratio ◽

Thrombin Time ◽

Lysis Time ◽

Coagulation Tests ◽

At Iii ◽

Acute Mi ◽

Artery Disease

A blind prospective coagulation profile was performed on 147 patients with coronary artery disease (CAD). Theprofile consisted of Prothrombin time (PT), the maximum rate of fibrin production (turbidity) when measuring the PT (PT Vmax), Activated Partial Thromboplastin time (APTT), APTT Vmax, Thrombin time (TT), TT Vmax, Fibrinogen (F), plasma and serum Antithrombin III (At-III), Lysis Time (LT) and Lipoproteins (LP). All clotting times and turbidities were measured using a BioData CP-7; At-III was measured as the loss of thrombin clotting activity; F was measured as the total thrombin clottable protein; LT was measured by a modified CLUE test; LP was measured as a heparin-Mg produced turbidity.During 41 months of follow-up, 12 patients developed a new myocardial infarction (MI), and had significantly higher APTT Vmax (7.46 ± .30U vs. 6.21 ± .09U, p=.0001); PT Vmax (7.83 ± .27U vs. 6.46 ± .10U, p=.0002); TT Vmax (5.33 ± .32U vs. 4.20 ± LOU, p=.0014); and F (339.6 ± 12.2 mg/dl vs. 292.76 ± 4.6 mg/dl, p=.003) than patients who did not. Out of 37 patients with the highest PT Vmax (upper 25%), 27% developed acute MI, while only 2 (1.8%) of the remaining 110 developed MI, giving a risk ratio of 15.4, p=.0001. Similarly, 9 out of 12 infarctions occurred in the upper 25% of APTT Vmax, giving a risk ratio of 8.9, p=0.0004. MI was also predicted by TT Vmax with a risk ratio of 5.9 (p=0.0004) and by fibrinogen with a risk ratio of 4.8 (p=0.0018). No relationship between MI and the other coagulation tests was noted. Thus, 1. rates of fibrin growth may predict the occurrence of MI in CAD, and 2. soluble coagulation parameters are important in the pathogenesis of acute myocardial infarction.

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Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619844444 ◽

2019 ◽

Vol 9 (7) ◽

pp. 788-801

Author(s):

Francois Schiele ◽

Gilles Lemesle ◽

Denis Angoulvant ◽

Michel Krempf ◽

Serge Kownator ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Primary Care Physicians ◽

Healthcare Providers ◽

Therapeutic Targets ◽

Lipid Lowering ◽

Routine Practice ◽

Discharge Letter ◽

Acute Mi

In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient’s discharge, and containing the description of the patient’s history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.

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Left Ventricular Ejection Fraction 1 Year After Acute Myocardial Infarction Identifies the Benefits of the Long-Term Use of β-Blockers

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010159 ◽

2021 ◽

Vol 14 (4) ◽

Author(s):

Chan Soon Park ◽

Han-Mo Yang ◽

You-Jeong Ki ◽

Jeehoon Kang ◽

Jung-Kyu Han ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Acute Mi ◽

Β Blockers

Background: β-Blockers can improve prognosis after acute myocardial infarction. However, it remains unclear how long β-blockers should be prescribed. Methods: We included patients from the prospective, nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health registry and collected data on β-blockers and left ventricular ejection fraction (LVEF) at 1-year follow-up. Patients were stratified into 2 groups: 1001 patients with a 1-year LVEF<50% and 3007 patients with a 1-year LVEF≥50%. The primary outcome was 2-year all-cause mortality from the 1-year follow-up. Results: A total of 3177 patients received β-blockers at 1 year, and 151 patients died during the 2-year follow-up from 1 year after index hospitalization. β-Blockers showed survival benefits in patients with a 1-year LVEF<50% (log-rank P =0.001) but not in those with a 1-year LVEF≥50% (log-rank P =0.311). After adjusting covariates, β-blockers were associated with a 51% reduction in mortality in patients with a 1-year LVEF<50% ( P =0.020) but not in their counterparts ( P =0.322). Indeed, there was a prognostic interaction between the use of β-blockers at 1 year and 1-year LVEF ( P for interaction=0.004). Conclusions: Use of β-blockers at 1-year follow-up after acute MI was associated with improved outcomes in patients with an LVEF<50% at 1 year but not in those with an LVEF>50% at 1 year. This study provides valuable information about differential responsiveness to β-blockers according to 1-year LVEF and might suggest the proper duration of β-blockers after acute MI. Registration: URL: http://cris.nih.go.kr/cris/en/ ; Unique identifier: KCT0000863.

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EFFICACY OF INTRAVENOUS STREPTOKINASE IN ACUTE MYOCARDIAL INFARCTION: ACUTE AND FOLLOW UP STUDY

10.1055/s-0038-1642993 ◽

1987 ◽

Author(s):

R Lochan ◽

S Tyagi ◽

B S Yadav ◽

D K M Rao ◽

A Bhat ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular ◽

Control Group ◽

Coronary Angiogram ◽

Intravenous Streptokinase ◽

Follow Up Study ◽

Group I ◽

Acute Mi

The efficacy of intravenous streptokinase on recanalization of the 'infarct vessel' and its effect on left ventricular function was assessed in two groups of patients. Group I consisted of 90 consecutive patients (age 32-75 years, mean 56 years) received 500,000 units of intravenous streptokinase (STK) over 30 minutes within 6 hours of onset of acute myocardial infarction (MI). Forty-eight patients had anterior MI and forty-two had inferior MI. The control group consisted of forty survivors of acute MI comparable in age and site of infarction. In Group I, ten patients were administered STK after baseline coronary angiogram demonstrated total occlusion of infarct related coronary artery. In these patients, serial coronary angiogram were done at intervals of 30 minutes after STK infusion upto a period of 3 hours. Recanalization was seen in all cases within 75-135 minutes (average 120 minutes). Seventy-nine of STK group and all of the control group underwent selective coronary arteriography and contrast left ventriculography within 48 to 72 hours of acute MI. Recanalization of infarct related artery was demonstrated in 72 out of 79 patients (91%) in STK group while 8 (20%) in control group had spontaneous recanalization. Left ventricular ejection fraction (LVEF) was higher in STK group (58%) as compared to control group (49%). Among patients with anterior MI, LVEF was significantly better in STK compared to control group (59% Vs. 44%, p > 0.01)while in inferior MI the difference was not significant (63% Vs. 59.4%, p > 0.05) in the two groups. Follow up study in 20 STK patients at 6 months revealed a decrease in residual stenosis from 75 ± 8% to 60 ± 6% and improvement in LVEF from 59 ± 8% to 68 ± 12% (p > 0.01). In conclusion, intravenous STK in acute MI results in high rate of infarct vessel patency and improved global left ventricular function during both early and late follow up period.

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