This Article Full Text Full Text (PDF) All Versions of this Article: 106/24/3051    most recent 01.CIR.0000043022.44032.77v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yamamuro, A. Articles by Morioka, S. Search for Related Content PubMed PubMed Citation Articles by Yamamuro, A. Articles by Morioka, S. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Heart Attack Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC Acute myocardial infarction

(Circulation. 2002;106:3051.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

Atsushi Yamamuro, MD; Takashi Akasaka, MD; Koichi Tamita, MD; Kenji Yamabe, MD; Minako Katayama, MD; Tsutomu Takagi, MD; Shigefumi Morioka, MD

From the Division of Cardiology, Kobe General Hospital, Kobe, Japan, and Division of Cardiology, Kawasaki Medical School (T.A.), Kurashiki, Japan.

Correspondence to Atsushi Yamamuro, MD, Minatojima-nakamachi 4-6, Chuo-ku, Kobe, 650-0046, Japan. E-mail minakozk{at}gold.ocn.ne.jp

Background— Recently, it was reported that the degree of microvascular injury and left ventricular functional recovery during the chronic period can be predicted after treatment of the infarct-related artery based on the coronary flow velocity (CFV) pattern assessed using a Doppler guidewire. The aim of this prospective study was to examine whether the CFV pattern may predict complications and in-hospital survival after acute myocardial infarction (AMI).

Methods and Results— The study population consisted of 169 consecutive patients with a first anterior AMI successfully treated with percutaneous coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. In accordance with previous findings, we defined severe microvascular injury as a diastolic deceleration time 600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascular injury (n=118; group 1) and those with severe microvascular injury (n=51; group 2). All of the patients who had cardiac rupture were in group 2. Congestive heart failure (CHF) was observed more frequently in group 2 than in group 1 (53% versus 8%, P<0.001). The in-hospital cardiac mortality rate was significantly higher in group 2 than in group 1 (18% versus 0%, P<0.001). Nine patients in group 2 died, 5 patients because of CHF and 4 patients because of cardiac rupture.

Conclusions— These findings suggest that the CFV pattern is an accurate predictor of the presence or absence of complications and of in-hospital survival after AMI.

Key Words: myocardial infarction • prognosis • microcirculation • reperfusion • ultrasonics

This article has been cited by other articles:

				A. Hirsch, R. Nijveldt, J. D.E. Haeck, A. M. Beek, K. T. Koch, J. P.S. Henriques, R. J. van der Schaaf, M. M. Vis, J. Baan Jr, R. J. de Winter, et al. Relation between the assessment of microvascular injury by cardiovascular magnetic resonance and coronary Doppler flow velocity measurements in patients with acute anterior wall myocardial infarction. J. Am. Coll. Cardiol., June 10, 2008; 51(23): 2230 - 2238. [Abstract] [Full Text] [PDF]

				T. Kawamoto, H. Okura, Y. Koyama, I. Toda, H. Taguchi, K. Tamita, A. Yamamuro, Y. Yoshimura, Y. Neishi, E. Toyota, et al. The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1635 - 1640. [Abstract] [Full Text] [PDF]

				J.-e. Obata, Y. Kitta, H. Takano, Y. Kodama, T. Nakamura, A. Mende, K.-i. Kawabata, Y. Saitoh, D. Fujioka, T. Kobayashi, et al. Sirolimus-Eluting Stent Implantation Aggravates Endothelial Vasomotor Dysfunction in the Infarct-Related Coronary Artery in Patients With Acute Myocardial Infarction J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1305 - 1309. [Abstract] [Full Text] [PDF]

				P. Sorajja, B. J. Gersh, D. A. Cox, M. G. McLaughlin, P. Zimetbaum, C. Costantini, T. Stuckey, J. E. Tcheng, R. Mehran, A. J. Lansky, et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction Eur. Heart J., July 2, 2007; 28(14): 1709 - 1716. [Abstract] [Full Text] [PDF]

				N. Westerhof, C. Boer, R. R. Lamberts, and P. Sipkema Cross-talk between cardiac muscle and coronary vasculature. Physiol Rev, October 1, 2006; 86(4): 1263 - 1308. [Abstract] [Full Text] [PDF]

				Y Ohara, Y Hiasa, T Takahashi, K Yamaguchi, R Ogura, T Ogata, K Yuba, K Kusunoki, S Hosokawa, K Kishi, et al. Relation between the TIMI frame count and the degree of microvascular injury after primary coronary angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2005; 91(1): 64 - 67. [Abstract] [Full Text] [PDF]

				A. P. Furber, F. Prunier, H. C. P. Nguyen, S. Boulet, S. Delepine, and P. Geslin Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events Circulation, December 7, 2004; 110(23): 3527 - 3533. [Abstract] [Full Text] [PDF]

				P. Voci, F. Pizzuto, and F. Romeo Coronary flow: a new asset for the echo lab? Eur. Heart J., November 1, 2004; 25(21): 1867 - 1879. [Full Text] [PDF]

				C. M. Gibson, J. Karha, S. A. Murphy, J. A. de Lemos, D. A. Morrow, R. P. Giugliano, M. T. Roe, R. A. Harrington, C. P. Cannon, E. M. Antman, et al. Association of a pulsatile blood flow pattern on coronary arteriography and short-term clinical outcomes in acute myocardial infarction J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1170 - 1176. [Abstract] [Full Text] [PDF]

				M. Bax, R. J. de Winter, C. E. Schotborgh, K. T. Koch, M. Meuwissen, M. Voskuil, R. Adams, K. J. J. Mulder, J. G. P. Tijssen, and J. J. Piek Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 534 - 541. [Abstract] [Full Text] [PDF]

				S. Kaul and H. Ito Microvasculature in Acute Myocardial Ischemia: Part II: Evolving Concepts in Pathophysiology, Diagnosis, and Treatment Circulation, January 27, 2004; 109(3): 310 - 315. [Full Text] [PDF]

				P. Garot Prognostic significance of coronary blood flow velocity patterns in patients with reperfused acute myocardial infarction and TIMI-2 flow J. Am. Coll. Cardiol., July 2, 2003; 42(1): 182 - 182. [Full Text] [PDF]