Clinical significance of coronary flow to the infarct zone before successful primary percutaneous transluminal coronary angioplasty in acute myocardial infarction.
OBJECTIVE
To assess the effect of coronary flow to the infarct zone before primary coronary angioplasty on hospital complications in patients with acute myocardial infarction (MI).


METHODS
Consecutive case series analysis.


METHODS
Coronary-care unit in a university hospital.


METHODS
Two hundred sixty-four consecutive patients with ST-elevation acute MIs who had successful primary percutaneous transluminal coronary angioplasty.


METHODS
Coronary angiography on hospital admission and serial echocardiography.


RESULTS
The status of infarct-related artery flow before primary angioplasty was evaluated on hospital admission. Left ventricular wall motion and pericardial effusions were studied by echocardiography. One hundred ninety patients had total occlusions (Thrombolysis in Myocardial Infarction [TIMI] flow grade, 0 to 1) in the infarct-related artery (group 1), and 74 patients had antegrade flow (TIMI flow grade, 2 to 3) [group 2] before undergoing primary angioplasty procedures. When group 1 was subdivided into two groups (for the presence and absence of collateral flow), the patients with total occlusions and no collateral flow had a higher incidence of left ventricular aneurysmal wall motion (11% vs 1%, respectively; p = 0.03) and pericardial friction rub (15% vs 3%, respectively; p = 0.03) than did those in group 2. Moreover, those patients with total occlusions and no collateral flow had higher incidences of pericardial effusion (34% vs 17%, respectively; p = 0.02; and 34% vs 9%, respectively; p < 0.01) and in-hospital mortality (8% vs 1%, respectively; p = 0.04; and 8% vs 1%, respectively; p = 0.06) than did those patients in the other two groups.


CONCLUSIONS
Despite successful primary angioplasty, the absence of antegrade flow in the infarct-related artery and collateral flow to the infarct zone before angioplasty resulted in a higher incidence of in-hospital complications.
Hatada
K
K
Cardiovascular Division, Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan. hatada@takii.kmu.ac.jp
Sugiura
T
T
Kamihata
H
H
Nakamura
S
S
Takahashi
N
N
Yuasa
F
F
Iwasaka
T
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors