Abstract 1683: Impact of Microvascular Injury on Long-Term Mortality After Primary Coronary Intervention for Acute Myocardial Infarction
Background: Recent studies have shown that severe microvascular injury can be assessed from coronary flow velocity (CFV) pattern by using a Doppler guidewire in patients with acute myocardial infarction (AMI). However, the relationship between CFV pattern and long-term cardiovascular events has not been evaluated. The aim of this prospective study was to examine whether the CFV pattern may predict the long-term cardiovascular events.
Methods: The study population consisted of 185 consecutive patients with a first anterior AMI successfully treated with primary coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. According to our previous reports, we defined severe micriovascular injury as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascualr injury (n=127; group 1) and those with severe microvascualr injury (n=58; group 2). We evaluated the association between the severe microvascular injury and the long-term major adverse cardiovascular event (MACE) rates.
Results: The median follow-up period was 5.1 years. All of the patients who had in-hospital mortality belonged to group 2. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p<0.0001). Risk-adjusted data by multivariate analysis showed that the severe microvascular injury was the strongest predictor for long-term MACE (hazard ratio: 4.87; 95% CI, 1.85–12.83; p=0.001).
Conclusion: The CFV pattern immediately after PCI is an accurate predictor of the long-term cardiovascular events in patients with anterior AMI.