title: Residual flow to the infarct zone against lethal ventricular tachyarrhythmias during the acute phase of myocardial infarction.
abstract: 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.
authors.affiliation: Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Yang
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: 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*