Residual flow to the infarct zone against lethal ventricular tachyarrhythmias during the acute phase of myocardial infarction.
BACKGROUND
The benefits of residual flow to the infarct zone have been demonstrated in acute myocardial infarction (AMI), but its relation to ventricular tachyarrhythmias remains uncertain.


OBJECTIVE
This study was undertaken to test the hypothesis that residual flow is an important determinant of lethal ventricular tachyarrhythmias (sustained ventricular tachycardia or ventricular fibrillation) during the acute phase of AMI.


METHODS
We investigated the determinants of lethal ventricular tachyarrhythmias within 24 h after the onset of symptoms in 310 consecutive patients (256 men; age 57.4 +/- 11.5 years) with AMI undergoing primary angioplasty. Patients were divided into two groups: those with (Group 1, n = 40) and those without (Group 2, n = 270) lethal ventricular tachyarrhythmias. Residual flow was defined as the presence of anterograde flow (> or = Thrombolysis in Myocardial Infarction [TIMI] 2 flow) or good angiographic collaterals (> or = grade 2) on a preintervention angiogram.


RESULTS
Univariate determinants of lethal ventricular tachyarrhythmias were cardiogenic shock, systolic blood pressure, peak level of creatine kinase, culprit artery, spontaneous reperfusion, and residual flow. In multivariate analysis, however, cardiogenic shock (odds ratio [OR] = 4.79, 95% confidence interval [CI] 1.63-14.11, p = 0.004), residual flow (OR = 0.34, 95% CI 0.14-0.81, p = 0.015), and the right coronary artery as the culprit artery (OR = 2.09,95% CI 1.03-4.22, p = 0.040) were independent determinants of these arrhythmias. In-hospital death occurred in 10 patients and was more common in Group 1 than in Group 2 (12.5% vs. 1.9%, respectively, p < 0.001).


CONCLUSIONS
The absence of residual flow was associated with greater risk of lethal ventricular tachyarrhythmias during the acute phase of AMI, suggesting a protective role of residual flow against these arrhythmias in AMI.
Yang
Hyun Suk
HS
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Lee
Jae-Hwan
JH
Nam
Gi-Byoung
GB
Choi
Kee-Joon
KJ
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Kim
You-Ho
YH
Park
Seung-Jung
SJ
D017130:Angioplasty; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D017180:Tachycardia, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*