Echocardiographic Predictors of Remote Outcome in Patients With Angiographically Successful Reflow After Acute Myocardial Infarction

Abstract

ercutaneous coronary intervention (PCI) is now routine for patients with acute myocardial infarction (AMI), and is increasingly used to treat complex coronary lesions with good long-term outcome. However, in the multicenter Lescol Intervention Prevention Study, 1 the annual risk of a major adverse cardiac event, defined as cardiac death, nonfatal myocardial infarction (MI) or a reintervention procedure (eg, coronary artery bypass grafting (CABG), repeat PCI, or PCI for a new lesion) approached 7%.Early restoration of coronary antegrade flow limits the progression of myocardial necrosis and is thus expected to enhance the functional recovery of postischemic dysfunction of the myocardium in patients with AMI. [2][3][4] Previous studies have demonstrated that 'angiographic no-reflow' predicts poor left ventricular (LV) functional recovery and a higher risk of cardiac mortality during the early phase and long-term follow-up period in patients with AMI. 5,6 However, the long-term prognosis after AMI remains unexplored in patients with angiographically successful reflow (TIMI (Thrombolysis in Myocardial Infarction) flow grade 3) after PCI.Several recent studies have proved the clinical usefulness of echocardiography in predicting outcome in patients with congestive heart failure (CHF), 7 AMI 8 and CABG, 9 but its long-term prognostic value in patients with angiographically successful reflow after AMI is unknown. Thus, in the present study we analyzed the long-term prognostic value of echocardiography in a consecutive series of patients with complete coronary revascularization by primary PCI for an initial AMI. Methods Patient PopulationOf 168 consecutive patients with AMI who were treated at Yamaguchi University Hospital, Japan, between January 1995 and January 2000, 113 (82 men, 31 women; age 46-84 years) were enrolled in the study. Criteria for inclusion were: (1) initial AMI; (2) a single-culprit lesion; (3) the infarct-related artery was recanalized with direct or rescue-PCI within 6 h of onset or between 6 and 24 h if evidence showed continuing ischemia; (4) residual stenosis Background The angiographically no-reflow phenomenon after percutaneous coronary intervention (PCI) predicts poor left ventricular (LV) functional recovery and a high risk of cardiac events in patients with their first acute myocardial infarction (AMI). However, risk factors of long-term adverse outcome for patients with angiographically successful reflow (TIMI (Thrombolysis in Myocardial Infarction) flow grade 3) for the AMI remain unknown. Methods and ResultsOf 168 echocardiograms were performed before PCI and at discharge, 113 were suitable for analysis. Clinical, angiographic, and echocardiographic variables were submitted to statistical analysis to detect the risk factors of cardiac events. During the follow-up period of 46±20 months, 31 patients had cardiac events, though there were no cardiac deaths. The 2 most important risk factors for congestive heart failure (CHF) or total cardiac events were LV dilation (chi-square: 7.5 and 9.4; ...

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