Abstract 19873: Prognostic Value of Thermodilution-derived Coronary Blood Flow Patterns After Percutaneous Coronary Intervention on Mid-term Left Ventricular Dilation in Patients with ST Elevation Myocardial Infarction
Background: We had reported the thermodilution-derived coronary blood flow pattern (CBFP) after percutaneous coronary intervention (PCI) associated with cardiac events in ST-segment elevation myocardial infarction (STEMI) patients. It was not well known whether the CBFP associated with the left ventricular (LV) dilation after successful PCI in STEMI patients.
Methods: Seventy-five patients with STEMI after PCI were enrolled prospectively in this study. Using a pressure sensor/thermistor-tipped guidewire, CBFP was assessed from the thermodilution-curves after PCI. CBFP was classified into 3 groups according to the shape of thermodilution-curve: a normal CBFP (n=39), a distal-embolization CBFP (n=26), or severe microvascular damage CBFP (n=10). Wall-motion score index (WMSI) and left ventricular diameter assessed by cardiac echo were analyzed within 2 weeks and 6 months after PCI serially. Percent change LV diastolic diameter (LVDd) was defined as (LVDd at 6monthes - LVDd at acute phase) / LVDd at acute phase х 100.
Results: Although WMSI at 6 months improved rather than that at acute phase in all patients, WMSI at 6 months in patients with severe microvascular damage CBFP were significantly higher than that in patents with normal- and distal-embolization CBFP (1.7±0.4, 1.4±0.3 and 1.4±0.3, p=0.034, respectively). Percent change LVDd in severe microvascular damage CBFP was significantly higher than that in normal- and distal-embolization CBFP (7.2±5.9, -0.1±7.9 and 0±6.9, p=0.018, respectively). Patients with severe microvascular damage CBFP had a higher risk of LV dilation at 6 months (90%, 49% and 42%, p=0.033). Multivariate analysis revealed that severe microvascular damage CBFP was the only independent predictor of LV dilation at 6 months in STEMI patients (odds ratio, 12.4; 95% confidence interval, 1.23-125; P=0.03).
Conclusions: Severe microvascular damage CBFP is associated with LV dysfunction and LV dilation on 6 months after PCI. This easily assessable CBFP is useful to predict the mid-term LV dilatation for STEMI patients at the catheterization laboratory immediately after PCI.
Author Disclosures: A. Sumiyoshi: None. K. Fujii: None. M. Fukunaga: None. M. Nishimura: None. T. Saita: None. T. Horimatsu: None. H. Tamaru: None. K. Miki: None. T. Imanaka: None. T. Masuyama: None.
- © 2014 by American Heart Association, Inc.