Incomplete resolution of ST-segment elevation is a marker of transient microcirculatory dysfunction after stenting for acute myocardial infarction.
BACKGROUND
Incomplete ST-segment resolution (STR) after successful primary angioplasty for acute myocardial infarction (AMI) is associated with a poor prognosis. We used intracoronary Doppler velocimetry to investigate whether incomplete STR after primary angioplasty is a marker of severe microcirculatory dysfunction.


RESULTS
Fifty patients with < or =12-hour AMI underwent successful primary angioplasty and systematic stenting with a Doppler guidewire. Patients with incomplete (<50%) STR 60 minutes after TIMI 3 flow was restored had flow velocity features suggestive of severe microcirculatory dysfunction, including a higher incidence of early systolic retrograde flow (41% versus 9%, P=0.007) and lower coronary flow velocity reserve (CVR, 1.3 versus 1.6, P<0.001). CVR improved immediately after stenting in patients with > or =50% STR but not in patients with <50% STR. There was a significant correlation between STR and poststent CVR. At 3 months, CVR was similar in patients with <50% and > or =50% STR. However, left ventriculography indicated lower global (42% versus 55%, P=0.001) and regional (16% versus 20%, P=0.03) left ventricular ejection fractions and 201Tl rest-redistribution scintigraphy indicated a larger infarct size (34% versus 16% 201Tl defect, P=0.007) in patients with <50% STR.


CONCLUSIONS
After successful primary angioplasty with systematic stenting, <50% STR is a marker of severe albeit transient microcirculatory dysfunction in patients with AMI and is associated with more extensive myocardial damage.
CHU Bichat-Département de Cardiologie, 46, rue Henri Huchard, 75018 Paris, France. laurent.feldman@bch.ap-hop-paris.fr
Laurent J
LJ
Feldman
Pierre
P
Coste
Alain
A
Furber
Patrick
P
Dupouy
Michel S
MS
Slama
Jean-Pierre
JP
Monassier
Christophe
C
Tron
Antoine
A
Lafont
Marc
M
Faraggi
Dominique
D
Le Guludec
Jean-Luc
JL
Dubois-Randé
P Gabriel
PG
Steg
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D015607:Stents; D013318:Stroke Volume; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left
D015415:Biomarkers