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(Circulation. 2000;101:2361.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Relation of Phasic Coronary Flow Velocity Characteristics With TIMI Perfusion Grade and Myocardial Recovery After Primary Percutaneous Transluminal Coronary Angioplasty and Rescue Stenting

Takashi Akasaka, MD; Kiyoshi Yoshida, MD; Takahiro Kawamoto, MD; Shuichiro Kaji, MD; Yoshiaki Ueda, MD; Atsushi Yamamuro, MD; Tsutomu Takagi, MD; Takeshi Hozumi, MD

From the Department of Cardiology, Kobe General Hospital, Kobe (T.A., T.K., S.K., Y.U., A.Y., T.T., T.H.), and the Department of Cardiology, Kawasaki Medical School, Okayama (K.Y.), Japan.

Correspondence to Takashi Akasaka, MD, Department of Cardiology, Kawasaki Medical School, Matsushima 577, Kurashiki City, Okayama, 701-0192, Japan. E-mail akasaka{at}med.kawasaki-m.ac.jp

Background—A residual stenosis and/or microvascular damage have been proposed as mechanisms of TIMI 2 flow for acute myocardial infarction. Coronary flow dynamics were assessed in patients with TIMI 2 flow to predict whether additional intervention would improve TIMI grade.

Methods and Results—In 35 patients who had a successfully recanalized anterior acute myocardial infarction using angioplasty or rescue stenting, coronary flow patterns were compared with corresponding TIMI grade and regional left ventricular wall motion (LVWM) 1 month after the intervention. After angioplasty, the time-averaged peak velocity (APV) was lower in patients with TIMI 2 flow (n=22) than in those with TIMI 3 flow (n=13; 7.9±3.9 versus 20.6±5.1 cm/s; P<0.001). Two different flow patterns were recorded in patients with TIMI 2 flow (versus TIMI 3, P<0.001); patients with type 1 TIMI 2 flow (n=15) had a reduced diastolic APV (8.3±4.8 versus 24.2±7.4 cm/s), prolonged diastolic deceleration time (1176±455 versus 728±205 ms), and a small diastolic/systolic APV ratio (1.3±0.6 versus 2.1±0.7); patients with type 2 TIMI 2 flow (n=7) had systolic flow reversal (systolic APV, -7.9±4.6 versus 11.7±4.5 cm/s), a rapid diastolic deceleration time (221±84 versus 728±205 ms), and a negative diastolic/systolic APV ratio (-2.1±1.4 versus 2.1±0.7). A significantly lower mean chord LVWM (-3.0±0.2 versus -1.9±0.8; P<0.001) and a greater number of chords <-2SD (50±2 versus 28±18; P<0.001) were present in patients with type 2 versus type 1 TIMI 2 flow. Stenting increased TIMI 2 flow to TIMI 3 flow more in patients with type 1 than type 2 flow (67% versus 0%; P=0.003). Patients with TIMI 2 flow after stenting continued to demonstrate a type 2 pattern, and they had poor LVWM recovery.

Conclusions—The differentiation between 2 types of TIMI 2 flow can predict the improvement of TIMI grade and LVWM recovery after additional stenting.

Key Words: angioplasty • coronary disease • diagnosis • myocardial infarction • reperfusion

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