Abstract 2262: Coronary Flow Reserve Immediately After Primary Coronary Stenting for Acute Myocardial Infarction Predicts Long-Term Adverse Cardiac Events
Background: Coronary flow reserve (CFR) evaluated immediately after reperfusion is thought to reflect the degree of microvascular injury and predict left ventricular functional recovery after acute myocardial infarction (AMI). We hypothesized that the CFR immediately after reperfusion would predict long-term adverse cardiac events.
Methods: Using a Doppler guidewire, we evaluated the CFR immediately after primary coronary stenting in 115 consecutive patients with a first anterior AMI. According to previous reports, the patients were divided into 2 groups: those with CFR <1.4 (n = 60) and those with CFR ≥ 1.4 (n = 55). Adverse cardiac events combining cardiac death, recurrent MI, and congestive heart failure were recorded during an average follow-up of 62 ± 32 months.
Results: At the end of follow-up, 93 of the 109 surviving patients (85%) were free of long-term cardiac events. Kaplan-Meier survival analysis showed a higher incidence of adverse cardiac events in patients with CFR <1.4 (p = 0.0013). In a multivariate model, final TIMI flow grade ≤2 (OR 3.7, 95% CI 1.1 to 12.9, P=0.03), ejection fraction ≤40% (OR 4.3, 95% CI 1.0 to 17.7, P=0.04), and CFR <1.4 (OR 5.6, 95% CI 1.2 to 25.1, P=0.02) were independent predictors of long-term adverse cardiac events.
Conclusion: The CFR evaluated immediately after primary coronary stenting is an accurate predictor of long-term adverse cardiac events after reperfused AMI.