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[Efficacy of combined therapy using coronary reperfusion and elective percutaneous transluminal coronary angioplasty for acute myocardial infarction].

The effects of elective percutaneous transluminal coronary angioplasty (PTCA) performed one month after coronary reperfusion therapy in patients with acute myocardial infarction (AMI) were observed using exercise Tl-201 myocardial scintigraphy performed before and after PTCA. Myocardial perfusion in Tl-201 scintigraphy was significantly greater in the early (less than 4 hours) and late (4-9 hours) reperfusion groups than in the total occlusion group one month after the onset of AMI. Both reperfusion groups showed significant improvement in myocardial perfusion after elective PTCA; whereas, the total occlusion group showed no significant improvement. In the early reperfusion group, there were no significant differences in myocardial perfusion between those with well developed and those with poorly developed collateral circulations one month after the onset of AMI. However, in the late reperfusion group, myocardial perfusion was greater in those with well developed collateral circulations compared to those with poorly developed collateral circulations. The grade of myocardial perfusion in the late reperfusion group with poorly developed collateral circulations did not differ significantly from that of the total occlusion group. There was significant improvement of myocardial perfusion in the early and late reperfusion groups with well developed collateral circulations after elective PTCA; whereas, no significant improvement was observed in the late reperfusion group with poorly developed collateral circulations. These findings indicate that the time interval from the onset of AMI to reperfusion and the grade of development of collateral circulations are the major determinants of myocardial perfusion after elective PTCA and after reperfusion therapy.