Abstract 19059: Thermodilution-derived Coronary Blood Flow Pattern Immediately After Coronary Intervention as a Predictor of Long-term Clinical Outcomes in Patients With ST-segment Elevation Myocardial Infarction
Background: We reported that coronary blood flow (CBF) can be evaluated by analyzing thermodilution curve that is measured with a single pressure sensor/thermistor-tipped guidewire in the cardiac catheterization laboratory during percutaneous coronary intervention (PCI). Bimodal shape of thermodilution curve was associated with microvascular damage and predictors of left ventricular functional recovery after ST-segment elevation myocardial infarction (STEMI). However it is unknown whether the bimodal shape of thermodilution curve predicts mortality and re-hospitalization for heart failure in long term period for patients experiencing STEMI.
Methods: Between September 2009 and August 2012, 97 consecutive patients with a first STEMI were prospectively enrolled in this study. Using a pressure sensor/thermistor-tipped guidewire, CBF pattern was assessed from the thermodilution-curves after successful PCI at maximum hyperemia. CBF pattern was classified into 3 groups according to the shape of thermodilution curve: a narrow unimodal (a rapid fall and rise of temperature-time curves) (n=47), a wide unimodal (a gradual fall and rise of temperature-time curves) (n=33), or bimodal (two populations with valley deeper than 20% of peak temperature drop) (n=17). Major adverse cardiac events (MACE) were defined as cardiac death and/or heart failure re-hospitalization within this study period.
Results: Median follow-up period was 2.4 years. Although patients in the narrow-unimodal group and the wide unimodal group had a significantly lower incidence of MACE, patients in bimodal group had a higher risk of MACE during this study period (71, 15, 21%, p<0.001). Multivariate analysis revealed that bimodal shape of the thermodilution-curve was the only independent predictor of MACE after STEMI (hazard ratio, 8.38; 95% confidence interval, 2.13-33.00; P=0.0023).
Conclusions: A bimodal shape of the thermodilution curve is associated with the poor long-term clinical outcomes. This easily assessable coronary flow pattern is useful in clinical risk stratification for STEMI patients in the cardiac catheterization laboratory immediately after PCI.
Author Disclosures: M. Fukunaga: None. K. Fujii: None. M. Nishimura: None. T. Horimatsu: None. T. Saita: None. A. Sumiyoshi: None. H. Tamaru: None. K. Miki: None. T. Imanaka: None. T. Masuyama: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.