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

Abstract

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.

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

“…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.…”

“…However, microvascular injury is determined not only by the size of the infarct but also by reperfusion injury, 16 PTCA-induced thrombus, and atheroma fragmentation. 17 Indeed, patients with severe microvascular injury immediately after PTCA have a higher frequency of ST-segment re-elevation 11 or incomplete ST-segment resolution, 18 and a continuously declining post-PTCA velocity has been linked to vessel reocclusion. 19 Several studies have shown that patients with no reflow on myocardial contrast echocardiography 20 or Doppler guidewire assessment 9,11,12 have poor functional LV recovery and a high frequency of complications such as CHF, pericardial effusion, cardiac tamponade, and cardiac rupture.…”

“…Doppler signals were difficult to analyze in 5 patients (7.3%), a rate in keeping with previous studies of Doppler recordings in the acute phase of MI. 11,18 We did not measure the cardiac function of long-term survivors. The impact of stenting on coronary microvascular function and the long-term risk of clinical events are not discussed because the number of stented patients was too small.…”

“…6,7 Studies using a Doppler guidewire have shown that coronary blood flow velocity (CFV) measurement in recanalized infarcted arteries can predict recovery of regional left ventricular (LV) function, 8 -10 as well as in-hospital complications and survival. 11 However, the relationship between the CFV pattern after reperfusion and long-term cardiac events is not fully clear. We postulated that qualitative and quantitative CFV alterations might be associated with the risk of inhospital and long-term adverse clinical events.…”

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

“…The attenuated CFR response post PCI seems to be associated with future cardiovascular events. 22 Recently, several studies have tested other invasive indexes in comparison with CFR, e.g., index of microvascular resistance and hyperemic microvascular resistance index, pointing out promising data about reproducibility and prognostic value. 23,24 All together, these insights from clinical pathophysiology could support therapeutic approaches beyond the primary PCI procedure itself.…”