Coronary recanalization in anterior myocardial infarction: the open perforator hypothesis.
OBJECTIVE
Patent perforators, noninvasively imaged by transthoracic color-Doppler echocardiography, may reflect adequate reperfusion in anterior myocardial infarction (MI).


BACKGROUND
The Thrombolysis In Myocardial Infarction (TIMI) classification may not fully reflect adequate myocardial reperfusion in MI.


METHODS
We studied 61 patients with anterior MI undergoing thrombolysis (n = 28), primary stenting (n = 20), or neither one (n = 13). High-resolution color-Doppler ultrasound was used to image the left anterior descending coronary artery (LAD) and perforators in four segments of the anterior-apical wall and to build a new recanalization score (RS). The TIMI flow was assessed by angiography. Wall motion score index (WMSI), ejection fraction (EF), end-diastolic volume index, and end-systolic volume index (ESVI) were measured by echocardiography at baseline and at three-month follow-up. Linear regression equations, considering RS or TIMI flow as independent variables, were compared among these functional recovery parameters. A multivariate linear model, predicting percent changes of WMSI, EF, or ESVI, was used to investigate the contribution of several clinical covariates along with RS and TIMI flow.


RESULTS
Sensitivity, specificity, and diagnostic accuracy of color-Doppler ultrasound in detecting LAD patency were 86%, 98%, and 97%, respectively. Mean and peak flow velocities discriminated (0.004 < p < 0.008) TIMI flow but not RS. Regression equations showed that RS discriminated better than TIMI flow recovery of ventricular function (p < 0.012). The RS was the best single multivariate predictor (p < 0.0001) of percent changes in WMSI, EF, and ESVI.


CONCLUSIONS
Transthoracic color-Doppler ultrasound detects an open LAD after MI. Perforators reflect adequate myocardial reperfusion and are early noninvasive markers of myocardial viability.
Voci
Paolo
P
Section of Cardiology, La Sapienza University, Rome, Italy. voci@uniroma1.it
Mariano
Enrica
E
Pizzuto
Francesco
F
Puddu
Paolo Emilio
PE
Romeo
Francesco
F
D000368:Aged; D000704:Analysis of Variance; D016477:Artifacts; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color / Q000592:standards*; D017548:Echocardiography, Transesophageal / Q000592:standards*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D013318:Stroke Volume; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency