Published Online
on November 22, 2004

A more recent version of this article appeared on December 7, 2004

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Submitted on June 1, 2004
Revised on July 21, 2004
Accepted on August 3, 2004

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

Alain P. Furber MD, PhD^*, Fabrice Prunier MD, Hoang Cuong Phan Nguyen MD, Stéphane Boulet MD, Stéphane Delépine MD, and Philippe Geslin MD

From the Department of Cardiology, Angers University Hospital, Angers, France.

^* To whom correspondence should be addressed. E-mail: AlFurber{at}chu-angers.fr.

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, 3.8±1.7 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 65 years, time from onset of chest pain to PTCA 6 hours, peak creatine kinase >4000 IU/L, ejection fraction 50%, proximal left anterior descending artery occlusion, resting average peak velocity 10 cm/s, average systolic peak velocity 5 cm/s, a rapid diastolic deceleration time (600 ms), and early retrograde systolic flow. In the final multivariate model, only age 65 years (OR, 3.6; 95% CI, 1.1 to 11.8; P=0.03), time to PTCA 6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; P=0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; P=0.01) 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.

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

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