Abstract 17217: Prognostic Significance of Thermodilution-derived Coronary Blood Flow Patterns Immediately After Coronary Intervention with TIMI-2 Flow in Patients with ST-segment Elevation Myocardial Infarction
Background: Although several studies have reported TIMI-2 flow immediately after percutaneous coronary intervention (PCI) leads to patient’s outcome worsein patients with ST-segment elevation myocardial infarction (STEMI), not all patients with TIMI 2 flow have a poor prognosis after STEMI. This study evaluates whether the coronary blood flow pattern (CBFP) predicts the clinical risk stratification in patients with TIMI-2 flow immediately after PCI.
Methods: Forty-five patients with TIMI-2 flow immediately after PCI were prospectively enrolled in this study. Using a pressure sensor/thermistor-tipped guidewire, CBFP was assessed from the thermodilution-curves after PCI. All patients were divided into 2 groups according to the shape of their thermodilution-curve: the wide-unimodal (n=29), or the bimodal (n=16). Peak CPK, Wall-motion score index (WMSI) and microvascular obstruction (MVO) appearance assessed by cardiovascular magnetic resonance were analyzed within 2 weeks after PCI. The primary end-point was cardiac events (cardiac death and/or heart failure re-hospitalization).
Results: Median follow-up period was 2.4 years. Although there were no significant differences in peak CPK, WMSI and MVO appearance between 2 groups, patients in the bimodal group had a higher risk of cardiac events than patients in the wide-unimodal group during this study period (p=0.00013). Multivariate analysis revealed that bimodal shape of thermodilution-curve was the only independent predictor of cardiac events in patients with TIMI-2 flow (hazard ratio, 4.95; 95% confidence interval, 1.71-14.34; P=0.0032).
Conclusions: At least two different CBFP are noted in patients with primary reperfused STEMI who have TIMI-2 flow.. Only the patients who had bimodal shape of thermodilution-curve had poor outcomes even after primary PCI. This easily assessable CBFP is useful in long-term clinical risk stratification for STEMI patients with TIMI 2 flow at the catheterization laboratory immediately after PCI.
Author Disclosures: M. Nishimura: None. K. Fujii: None. M. Fukunaga: None. T. Imanaka: None. K. Miki: None. H. Tamaru: None. T. Horimatsu: None. T. Saita: None. T. Masuyama: None.
- © 2014 by American Heart Association, Inc.