Published Online
on November 25, 2002

A more recent version of this article appeared on December 10, 2002

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Submitted on July 30, 2002
Revised on September 24, 2002
Accepted on September 26, 2002

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

Atsushi Yamamuro MD^*, Takashi Akasaka MD, Koichi Tamita MD, Kenji Yamabe MD, Minako Katayama MD, Tsutomu Takagi MD, and Shigefumi Morioka MD

From the Division of Cardiology, Kobe General Hospital, Kobe, Japan, and Division of Cardiology, Kawasaki Medical School (T.A.), Kurashiki, Japan.

^* To whom correspondence should be addressed. E-mail: minakozk{at}gold.ocn.ne.jp.

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.

Key words: myocardial infarction • prognosis • microcirculation • reperfusion • ultrasonics

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