Published Online
on May 12, 2003

A more recent version of this article appeared on June 3, 2003

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Submitted on November 19, 2002
Revised on February 27, 2003
Accepted on March 3, 2003

Incomplete Resolution of ST-Segment Elevation Is a Marker of Transient Microcirculatory Dysfunction After Stenting for Acute Myocardial Infarction

Laurent J. Feldman MD, PhD^*, Pierre Coste MD, Alain Furber MD, Patrick Dupouy MD, Michel S. Slama MD, Jean-Pierre Monassier MD, Christophe Tron MD, Antoine Lafont MD, PhD, Marc Faraggi MD, PhD, Dominique Le Guludec MD, PhD, Jean-Luc Dubois-Randé MD, PhD, P. Gabriel Steg MD, and for the FRench Optimal STenting (FROST)-2 Investigators

From CHU Bichat AP-HP, Paris, France (L.J.F., M.F., D.L.G., P.G.S.); CHU Haut-Lévêque, Bordeaux, France (P.C.); CHU Angers, France (A.F.); CHU Henri Mondor, Créteil, France (P.D., J.-L.D.R.); CHU Antoine Béclère, Clamart, France (M.S.S.); Hôpital Emile Muller, Mulhouse, France (J.-P.M.); CHU Charles Nicolle, Rouen, France (C.T.); and Hôpital Européen Georges Pompidou, Paris, France (A.L.).

^* To whom correspondence should be addressed. E-mail: laurent.feldman{at}bch.ap-hop-paris.fr.

Background--Incomplete ST-segment resolution (STR) after successful primary angioplasty for acute myocardial infarction (AMI) is associated with a poor prognosis. We used intracoronary Doppler velocimetry to investigate whether incomplete STR after primary angioplasty is a marker of severe microcirculatory dysfunction.

Methods and Results--Fifty patients with 12-hour AMI underwent successful primary angioplasty and systematic stenting with a Doppler guidewire. Patients with incomplete (<50%) STR 60 minutes after TIMI 3 flow was restored had flow velocity features suggestive of severe microcirculatory dysfunction, including a higher incidence of early systolic retrograde flow (41% versus 9%, P=0.007) and lower coronary flow velocity reserve (CVR, 1.3 versus 1.6, P<0.001). CVR improved immediately after stenting in patients with 50% STR but not in patients with <50% STR. There was a significant correlation between STR and poststent CVR. At 3 months, CVR was similar in patients with <50% and 50% STR. However, left ventriculography indicated lower global (42% versus 55%, P=0.001) and regional (16% versus 20%, P=0.03) left ventricular ejection fractions and ²⁰¹Tl rest-redistribution scintigraphy indicated a larger infarct size (34% versus 16% ²⁰¹Tl defect, P=0.007) in patients with <50% STR.

Conclusions--After successful primary angioplasty with systematic stenting, <50% STR is a marker of severe albeit transient microcirculatory dysfunction in patients with AMI and is associated with more extensive myocardial damage.

Key words: myocardial infarction • angioplasty • stents • electrocardiography • microcirculation

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