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(Circulation. 2004;110:3527-3533.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Coronary Blood Flow Assessment After Successful Angioplasty for Acute Myocardial Infarction Predicts the Risk of Long-Term Cardiac Events

Alain P. Furber, MD, PhD; Fabrice Prunier, MD; Hoang Cuong Phan Nguyen, MD^*; Stéphane Boulet, MD^*; Stéphane Delépine, MD; Philippe Geslin, MD

From the Department of Cardiology, Angers University Hospital, Angers, France.

Correspondence to Dr Alain P. Furber, Service de Cardiologie, Centre Hospitalier Universitaire, 4 Rue Larrey, 49033 Angers Cedex 01, France. E-mail AlFurber{at}chu-angers.fr

Received June 1, 2004; revision received July 21, 2004; accepted August 3, 2004.

Background— Analysis of coronary flow velocity (CFV) in the recanalized infarct-related coronary artery (IRA) with a Doppler guidewire is useful for predicting recovery of regional left ventricular function, in-hospital complications, and survival. We postulated that the CFV pattern after IRA reperfusion for acute myocardial infarction (AMI) would predict long-term adverse cardiac events.

Methods and Results— Sixty-eight consecutive patients with a first AMI underwent CFV measurement with a Doppler guidewire after successful reopening of the IRA by coronary angioplasty. At the end of follow-up, 3.8±1.7 years after AMI, 44 of the 65 surviving patients (67.7%) were free of long-term cardiac events. Univariate analysis showed that the following factors were predictive of an end point combining cardiac death, recurrent MI, and congestive heart failure: hypertension, age 65 years, time from onset of chest pain to PTCA 6 hours, peak creatine kinase >4000 IU/L, ejection fraction 50%, proximal left anterior descending artery occlusion, resting average peak velocity 10 cm/s, average systolic peak velocity 5 cm/s, a rapid diastolic deceleration time (600 ms), and early retrograde systolic flow. In the final multivariate model, only age 65 years (OR, 3.6; 95% CI, 1.1 to 11.8; P=0.03), time to PTCA 6 hours (OR, 2.9; 95% CI, 1.0 to 8.3; P=0.04), and a rapid diastolic deceleration time (OR, 5.4; 95% CI, 1.5 to 19.3; P=0.01) were independent predictors.

Conclusions— The CFV pattern appears to be an accurate predictor of long-term cardiac events in patients having undergone successful reopening of the IRA after AMI, identifying a subset of at-risk patients.

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

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