Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

Wakatsuki, Tetsuzo; Nakamura, Masato; Tsunoda, Taro; Toma, Hiroko; Degawa, Toshiyuki; Oki, Takashi; Yamaguchi, Tetsu

doi:10.1016/s0735-1097(00)00632-x

Cited by 60 publications

(33 citation statements)

References 32 publications

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“…14,15,26 The findings of the present study revealed that AMI is often complicated by congestive heart failure when microvascular injury is severe and that severe microvascular injury is always present when cardiac rupture occurs after recanalization. Probably for this reason, in-hospital death could be predicted more accurately from the CFV pattern, which allows a more quantitative assessment of microvascular injury, than from the angiographic contrast velocity.…”

Section: Yamamuro Et Al Coronary Flow and Patient Outcomesmentioning

confidence: 55%

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

et al. 2002

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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). Methods and 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 ≤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.

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Section: Yamamuro Et Al Coronary Flow and Patient Outcomesmentioning

confidence: 55%

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

et al. 2002

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“…Contrary to TIMI flow grade, myocardial blush grade, corrected TIMI frame counts and ST-segment resolution, coronary flow velocity under maximal vasodilation, our primary end point, is an objective quantitative measure of perfusion that, in the absence of coronary artery stenoses, reflects the integrity of the distal vascular bed. [5][6][7][8][9] In a previous study, coronary flow velocity under maximal vasodilation proved to be a sensitive parameter for the microcirculatory effects of abciximab that positively affected recovery of contractile function. 8 Even with this sensitive parameter of myocardial perfusion, we were unable to find a beneficial effect of the filter wire on coronary circulation during reperfusion.…”

Section: Discussionmentioning

confidence: 96%

“…1,2 Despite restoration of large-vessel flow, tissue perfusion in area at risk frequently continues to be compromised, as shown by myocardial contrast echocardiography, 3,4 flow velocity measurements, [5][6][7][8][9] and assessment of TIMI frame counts 10,11 or myocardial blush. 12,13 Persistent microcirculatory impairment is associated with poor recovery of contractile function [3][4][5][6][7][8][9] and adverse clinical outcome. 3,10 -13 Apart from ischemic microvascular damage and reperfusion-induced regional inflammatory responses, distal embolization of plaque and thrombus material is considered a major cause of insufficient reperfusion despite a fully patent infarct-related artery.…”

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confidence: 99%

Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation

et al. 2005

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Background-In acute myocardial infarction, distal embolization of debris during primary percutaneous catheter intervention may curtail microvascular reperfusion of the infarct region. Our randomized trial investigated whether distal protection with a filter device can improve microvascular perfusion and reduce infarct size after primary percutaneous catheter intervention. Methods and Results-We enrolled 200 patients who had angina within 48 hours after onset of pain plus at least 1 of 3 additional criteria: ST-segment elevation, elevated myocardial marker proteins, and angiographic evidence of thrombotic occlusion. Among the patients included (83% men; mean age, 62Ϯ12 years), 100 were randomly assigned to the filter-wire group and 100 to the control group. The primary end point was the maximal adenosine-induced Doppler flow velocity in the recanalized infarct artery; the secondary end point was infarct size estimated by the volume of delayed enhancement on nuclear MRI. ST-segment elevation myocardial infarction was present in 68.5% of the patients; the median time from onset of pain was 6.9 hours. In the filter-wire group, maximal adenosine-induced flow velocity was 34Ϯ17 compared with 36Ϯ20 cm/s in the control group (Pϭ0.46). Infarct sizes, assessed in 82 patients in the filter-wire group and 78 patients in the control group, were 11.8Ϯ9.3% of the left ventricular mass in the filter-wire group and 10.4Ϯ9.4% in the control group (Pϭ0.33). Thirty-day mortality was 2% in filter-wire group and 3% in the control group. Conclusions-The filter wire as an adjunct to primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation did not improve reperfusion or reduce infarct size.

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“…Likewise, it has been reported that the CFV pattern immediately after primary coronary stenting may be predictive of LV functional recovery during the healing phase of AMI. 12,15 More recently, the CFV pattern was found to be an accurate predictor of in-hospital complications and survival after AMI. 11 Here, we show that both in-hospital and long-term adverse clinical events can be predicted by the CFV pattern both qualitatively and quantitatively immediately after primary or rescue PTCA, establishing a relationship between the risk of adverse clinical events and microcirculatory function measured by intracoronary Doppler examination.…”

Section: Discussionmentioning

confidence: 99%

Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events

et al. 2004

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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. Methods and 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, 3.8Ϯ1.7 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 Ն65 years, time from onset of chest pain to PTCA Ն6 hours, peak creatine kinase Ͼ4000 IU/L, ejection fraction Յ50%, proximal left anterior descending artery occlusion, resting average peak velocity Յ10 cm/s, average systolic peak velocity Յ5 cm/s, a rapid diastolic deceleration time (Յ600 ms), and early retrograde systolic flow. In the final multivariate model, only age Ն65 years (OR, 3.6; 95% CI, 1.1 to 11.8; Pϭ0.03), time to PTCA Ն6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; Pϭ0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; Pϭ0.01) 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.

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Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

Abstract: The coronary flow velocity pattern measured immediately after successful primary stenting is predictive of the recovery of regional and global LV function in patients with AMI.

Cited by 60 publications

References 32 publications

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation

Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events

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