Coronary flow velocity pattern immediately after percutaneous coronary intervention as a predictor of complications and in-hospital survival after acute myocardial infarction.
BACKGROUND
Recently, it was reported that the degree of microvascular injury and left ventricular functional recovery during the chronic period can be predicted after treatment of the infarct-related artery based on the coronary flow velocity (CFV) pattern assessed using a Doppler guidewire. The aim of this prospective study was to examine whether the CFV pattern may predict complications and in-hospital survival after acute myocardial infarction (AMI).


RESULTS
The study population consisted of 169 consecutive patients with a first anterior AMI successfully treated with percutaneous coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. In accordance with previous findings, we defined severe microvascular injury as a diastolic deceleration time < or =600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascular injury (n=118; group 1) and those with severe microvascular injury (n=51; group 2). All of the patients who had cardiac rupture were in group 2. Congestive heart failure (CHF) was observed more frequently in group 2 than in group 1 (53% versus 8%, P<0.001). The in-hospital cardiac mortality rate was significantly higher in group 2 than in group 1 (18% versus 0%, P<0.001). Nine patients in group 2 died, 5 patients because of CHF and 4 patients because of cardiac rupture.


CONCLUSIONS
These findings suggest that the CFV pattern is an accurate predictor of the presence or absence of complications and of in-hospital survival after AMI.
Yamamuro
Atsushi
A
Division of Cardiology, Kobe General Hospital, Kobe, Japan. minakozk@gold.ocn.ne.jp
Akasaka
Takashi
T
Tamita
Koichi
K
Yamabe
Kenji
K
Katayama
Minako
M
Takagi
Tsutomu
T
Morioka
Shigefumi
S
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003971:Diastole; D004301:Doppler Effect; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006341:Heart Rupture / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013599:Systole; D014463:Ultrasonography