Coronary blood flow assessment after successful angioplasty for acute myocardial infarction predicts the risk of long-term cardiac events.
BACKGROUND
Analysis of coronary flow velocity (CFV) in the recanalized infarct-related coronary artery (IRA) with a Doppler guidewire is useful for predicting recovery of regional left ventricular function, in-hospital complications, and survival. We postulated that the CFV pattern after IRA reperfusion for acute myocardial infarction (AMI) would predict long-term adverse cardiac events.


RESULTS
Sixty-eight consecutive patients with a first AMI underwent CFV measurement with a Doppler guidewire after successful reopening of the IRA by coronary angioplasty. At the end of follow-up, 3.8+/-1.7 years after AMI, 44 of the 65 surviving patients (67.7%) were free of long-term cardiac events. Univariate analysis showed that the following factors were predictive of an end point combining cardiac death, recurrent MI, and congestive heart failure: hypertension, age > or =65 years, time from onset of chest pain to PTCA > or =6 hours, peak creatine kinase >4000 IU/L, ejection fraction < or =50%, proximal left anterior descending artery occlusion, resting average peak velocity < or =10 cm/s, average systolic peak velocity < or =5 cm/s, a rapid diastolic deceleration time (< or =600 ms), and early retrograde systolic flow. In the final multivariate model, only age > or =65 years (OR, 3.6; 95% CI, 1.1 to 11.8; P=0.03), time to PTCA > or =6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; P=0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; P=0.01) were independent predictors.


CONCLUSIONS
The CFV pattern appears to be an accurate predictor of long-term cardiac events in patients having undergone successful reopening of the IRA after AMI, identifying a subset of at-risk patients.
Furber
Alain P
AP
Department of Cardiology, Angers University Hospital, Angers, France. AlFurber@chu-angers.fr
Prunier
Fabrice
F
Nguyen
Hoang Cuong Phan
HC
Boulet
Stéphane
S
Delépine
Stéphane
S
Geslin
Philippe
P
D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors