Abstract 12861: Assessment of Both Coronary Microvascular Damage and Epicardial Flow Velocity Measurement Immediately After Successful Percutaneous Coronary Intervention Predicts In-Hospital Complications and Survival in ST-Segment Elevation Myocardial Infarction
Background: Quantitative measurement of post-reperfusion epicardial flow velocity by a Doppler guidewire can predict clinical cardiac events in ST-segment elevation myocardial infarction (STEMI). It has also been reported that the coronary flow velocity pattern in patients with microvascular obstruction is characterized by the presence of early systolic retrograde flow and a rapid diastolic deceleration time (DDT). The purpose of this study was to examine the role of assessing both epicardial flow velocity and microvascular damage in the prediction of in-hospital complications and survival after percutaneous coronary intervention (PCI).
Methods: Two hundred and fifty-one consecutive patients with first anterior STEMI who underwent successful PCI were subjected to coronary flow measurement with a Doppler guidewire. The coronary flow velocity spectrum provided the following parameters: time-averaged peak velocity (cm/s, APV), systolic peak velocity (cm/s) and DDT (ms). We defined the presence of microvascular obstruction as DDT ≤600 ms and the presence of systolic flow reversal, and slow epicardial flow as resting APV ≤10cm/s. We classified the patients into three categories: without microvascular obstruction (group 1, n=140), with microvascular obstruction and normal epicardial flow (group 2, n= 51, with microvascular obstruction and slow epicardial flow (group 3, n=60). The clinical event rate was compared among the 3 groups.
Results: The in-hospital event rates for congestive heart failure (15/140 [11%], 15/51 [29%] and 34/60 [57%], respectively; P < 0.01), left ventricular thrombus (3/140 [2%], 9/51 [18%] and 14/60 [23%], respectively; P < 0.01), and cardiac rupture (0/140 [0%], 5/51 [10%], and 16/60 [27%]; P < 0.01) were highest in group 3 and lowest in group 1. Group 3 was at the highest risk of cardiac death, while group 1 was at the lowest (0/140 [0%], 3/51 [6%], and 12/60 [20%]; P < 0.01).
Conclusions: Assessment of both coronary microvascular damage and epicardial flow velocity can accurately predict in-hospital complications and survival in STEMI patients who underwent successful reperfusion of the infarct-related coronary artery, identifying a subset of high risk patients.
- Myocardial infarction, STEMI
- Cardiovascular imaging
- Intravascular ultrasound/Doppler
- Coronary microcirculation
Author Disclosures: A. Yamamuro: None. K. Tamita: None. J. Yoshikawa: None. K. Shuichiro: None. Y. Furukawa: None.
- © 2016 by American Heart Association, Inc.