| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;93:1993-1999.)
© 1996 American Heart Association, Inc.
Articles |
Myocardial Perfusion Patterns Related to Thrombolysis in Myocardial Infarction Perfusion Grades After Coronary Angioplasty in Patients With Acute Anterior Wall Myocardial Infarction
From the Division of Cardiology (H.I., A.O., K.I., S.T., S.N., Y.N., Y.T., Y.H., K.F., T. Minamino), Sakurabashi Watanabe Hospital, and The First Department of Medicine (T. Masuyama, M.H.), Osaka University School of Medicine, Osaka, Japan.
Correspondence to Hiroshi Ito, MD, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530, Japan.
Background Epicardial coronary flow is occasionally reduced even after coronary intervention despite the absence of vessel obstruction in patients with acute myocardial infarction. Our aim was to clarify the cause and outcomes of radiocontrast slow filling in patients with reperfused acute anterior myocardial infarction by assessing microvascular damage with the use of myocardial contrast echocardiography (MCE) and functional outcomes.
Methods and Results We carefully reviewed the cineangiograms of 86 patients who achieved coronary revascularization within 12 hours of the onset and underwent MCE before and soon after recanalization with the intracoronary injection of sonicated microbubbles. Antegrade coronary flow after recanalization was graded by two observers based on Thrombolysis in Myocardial Infarction (TIMI) trial flow grades. Left ventricular ejection fraction was measured on the day of infarction and 1 month later. TIMI grade 2 was observed in 18 patients (21%), and the other 68 patients manifested TIMI grade 3 after recanalization. All patients with TIMI 2 showed substantial MCE no reflow, whereas only 11 patients (16%) with TIMI 3 showed MCE no reflow. Functional improvement was worse in patients with TIMI 2 than in those with TIMI 3 (TIMI 2, 38±8% versus 40±8%, P=NS [acute versus late]; TIMI 3, 44±13% versus 55±13%, P<.001). Among patients with TIMI 3, significant functional improvement was observed only in patients with MCE reflow (MCE reflow, 46±13% versus 57±12%, P<.001; MCE no reflow, 35±11% versus 45±12%, P=NS).
Conclusions Despite no obstructive lesion of the vessel, TIMI 2 is caused by advanced microvascular damage and is a highly specific, although not sensitive, predictor of poor functional outcomes in patients with acute myocardial infarction. TIMI 3 does not necessarily indicate myocardial salvage, and detection of MCE no reflow in these patients is particularly useful for the prediction of functional outcome.
Key Words: angioplasty • myocardial infarction • echocardiography • microcirculation • reperfusion
This article has been cited by other articles:
 |
|
 |
|
  R. Jaffe, T. Charron, G. Puley, A. Dick, and B. H. Strauss Microvascular Obstruction and the No-Reflow Phenomenon After Percutaneous Coronary Intervention Circulation, June 17, 2008; 117(24): 3152 - 3156. [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Rochitte Microvascular obstruction the final frontier for a complete myocardial reperfusion. J. Am. Coll. Cardiol., June 10, 2008; 51(23): 2239 - 2240. [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Hayat and R. Senior Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Eur. Heart J., February 1, 2008; 29(3): 299 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Marques, P. Knaapen, R. Boellaard, N. Westerhof, A. A. Lammertsma, C. A. Visser, and F. C. Visser Hyperaemic microvascular resistance is not increased in viable myocardium after chronic myocardial infarction Eur. Heart J., October 1, 2007; 28(19): 2320 - 2325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Niccoli, G. A. Lanza, S. Shaw, E. Romagnoli, D. Gioia, F. Burzotta, C. Trani, M. A. Mazzari, R. Mongiardo, M. De Vita, et al. Endothelin-1 and acute myocardial infarction: a no-reflow mediator after successful percutaneous myocardial revascularization Eur. Heart J., August 1, 2006; 27(15): 1793 - 1798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y-J Yang, J-L Zhao, S-J You, Y-J Wu, Z-C Jing, W-X Yang, L Meng, Y-W Wang, and R-L Gao Different effects of tirofiban and aspirin plus clopidogrel on myocardial no-reflow in a mini-swine model of acute myocardial infarction and reperfusion Heart, August 1, 2006; 92(8): 1131 - 1137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Ferenc and F.-J. Neumann Efficacy of primary PCI: the microvessel perspective Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I4 - I9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gick, N. Jander, H.-P. Bestehorn, R.-P. Kienzle, M. Ferenc, K. Werner, T. Comberg, K. Peitz, D. Zohlnhofer, V. Bassignana, et al. Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation Circulation, September 6, 2005; 112(10): 1462 - 1469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sorajja, B. J. Gersh, C. Costantini, M. G. McLaughlin, P. Zimetbaum, D. A. Cox, E. Garcia, J. E. Tcheng, R. Mehran, A. J. Lansky, et al. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction Eur. Heart J., April 1, 2005; 26(7): 667 - 674. [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]
|
|
|
|
|
|
K. Iwakura, H. Ito, S. Kawano, A. Okamura, K. Tanaka, Y. Nishida, Y. Maekawa, and K. Fujii Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices Eur. Heart J., September 1, 2004; 25(17): 1526 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. O. Costantini, G. W. Stone, R. Mehran, E. Aymong, C. L. Grines, D. A. Cox, T. Stuckey, M. Turco, B. J. Gersh, J. E. Tcheng, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 305 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Reffemann and R. A. Kloner Microvascular Alterations After Temporary Coronary Artery Occlusion: The No-Reflow Phenomenon Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2004; 9(3): 163 - 172. [Abstract] [PDF]
|
|
|
|
|
|
M Sezer, Y Nisanci, B Umman, E Yilmaz, A Olcay, F Erzengin, and O Ozsaruhan New support for clarifying the relation between ST segment resolution and microvascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index Heart, February 1, 2004; 90(2): 146 - 150. [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]
|
|
|
|
|
|
H. Kunichika, O. Ben-Yehuda, S. Lafitte, N. Kunichika, B. Peters, and A. N. DeMaria Effects of glycoprotein iib/iiia inhibition on microvascular flow after coronary reperfusion: A quantitative myocardial contrast echocardiography study J. Am. Coll. Cardiol., January 21, 2004; 43(2): 276 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Kloner and W. Dai Glycoprotein IIb/IIIa inhibitors and no-reflow J. Am. Coll. Cardiol., January 21, 2004; 43(2): 284 - 286. [Full Text] [PDF]
|
|
|
|
|
|
H. Bonnemeier, U. K.H. Wiegand, F. Bode, F. Hartmann, V. Kurowski, H. A. Katus, and G. Richardt Impact of Infarct-Related Artery Flow on QT Dynamicity in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction Circulation, December 16, 2003; 108(24): 2979 - 2986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Hozumi, Y Kanzaki, Y Ueda, A Yamamuro, T Takagi, T Akasaka, S Homma, K Yoshida, and J Yoshikawa Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction Heart, October 1, 2003; 89(10): 1163 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-K. Yip, C.-J. Wu, H.-W. Chang, Y.-K. Hsieh, C.-Y. Fang, S.-M. Chen, and M.-C. Chen Impact of Tirofiban on Angiographic Morphologic Features of High-Burden Thrombus Formation During Direct Percutaneous Coronary Intervention and Short-term Outcomes Chest, September 1, 2003; 124(3): 962 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L Hale, M. W Dae, and R. A Kloner Hypothermia during reperfusion limits 'no-reflow' injury in a rabbit model of acute myocardial infarction Cardiovasc Res, September 1, 2003; 59(3): 715 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bonnemeier, U. K.H. Wiegand, J. Friedlbinder, S. Schulenburg, F. Hartmann, F. Bode, H. A. Katus, and G. Richardt Reflex Cardiac Activity in Ischemia and Reperfusion: Heart Rate Turbulence in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction Circulation, August 26, 2003; 108(8): 958 - 964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Limbruno, A. Micheli, M. De Carlo, G. Amoroso, R. Rossini, C. Palagi, V. Di Bello, A. S. Petronio, G. Fontanini, and M. Mariani Mechanical Prevention of Distal Embolization During Primary Angioplasty: Safety, Feasibility, and Impact on Myocardial Reperfusion Circulation, July 15, 2003; 108(2): 171 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Dibra, J. Mehilli, J. Dirschinger, J.u. Pache, J. Neverve, M. Schwaiger, A. Schomig, and A. Kastrati Thrombolysis in myocardial infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis J. Am. Coll. Cardiol., March 19, 2003; 41(6): 925 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Balcells, E. R. Powers, W. Lepper, T. Belcik, K. Wei, M. Ragosta, H. Samady, and J. R. Lindner Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve J. Am. Coll. Cardiol., March 5, 2003; 41(5): 827 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Karavidas, A. D. Vrachatis, M. A. Alpert, D. J. Nikas, D. J. Achtypis, M. G. Foukarakis, E. P. Matsakus, C. S. Thedocharis, and A. A. Zacharoulis Primary Stenting Produces Earlier and More Efficient Myocardial Reperfusion than Primary PTCA Alone in Patients with Acute ST Segment Elevation MI Angiology, March 1, 2003; 54(2): 195 - 203. [Abstract] [PDF]
|
|
|
|
|
|
K Greaves, S R Dixon, M Fejka, W W O'Neill, S R Redwood, M S Marber, and R Senior Myocardial contrast echocardiography is superior to other known modalities for assessing myocardial reperfusion after acute myocardial infarction Heart, February 1, 2003; 89(2): 139 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.S Petronio, D Rovai, G Musumeci, R Baglini, C Nardi, U Limbruno, C Palagi, D Volterrani, and M Mariani Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty Eur. Heart J., January 1, 2003; 24(1): 67 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Shimada, Y Sakanoue, Y Kobayashi, S Ehara, M Hirose, Y Nakamura, D Fukuda, H Yamagishi, M Yoshiyama, K Takeuchi, et al. Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2003; 89(1): 71 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Yamamuro, T. Akasaka, K. Tamita, K. Yamabe, M. Katayama, T. Takagi, and S. Morioka Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction Circulation, December 10, 2002; 106(24): 3051 - 3056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yamamoto, H. Ito, K. Iwakura, S. Kawano, M. Ikushima, T. Masuyama, T. Ogihara, and K. Fujii Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: Insight into mechanisms of microvascular dysfunction J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1755 - 1760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-K. Yip, M.-C. Chen, H.-W. Chang, C.-L. Hang, Y.-K. Hsieh, C.-Y. Fang, and C.-J. Wu Angiographic Morphologic Features of Infarct-Related Arteries and Timely Reperfusion in Acute Myocardial Infarction: Predictors of Slow-Flow and No-Reflow Phenomenon Chest, October 1, 2002; 122(4): 1322 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Reffelmann and R. A. Kloner Microvascular reperfusion injury: rapid expansion of anatomic no reflow during reperfusion in the rabbit Am J Physiol Heart Circ Physiol, September 1, 2002; 283(3): H1099 - H1107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y Ueno, Y Nakamura, M Kinoshita, T Fujita, T Sakamoto, and H Okamura Can coronary flow velocity reserve determined by transthoracic Doppler echocardiography predict the recovery of regional left ventricular function in patients with acute myocardial infarction? Heart, August 1, 2002; 88(2): 137 - 141. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Agati, S. Funaro, M. Madonna, C. Volponi, G. Veneroso, and G. Tonti Clinical utility of contrast echocardiography in the management of patients with acute myocardial infarction Eur. Heart J. Suppl., March 1, 2002; 4(suppl_C): C27 - C34. [Abstract] [PDF]
|
|
|
|
|
|
A. Distante, R. Dankowski, P. Mincarone, C.G. Leo, E. Gianicolo, P. Voci, M.A. Morales, and D. Rovai Contrast echocardiography and medical economics: looking into the crystal ball Eur. Heart J. Suppl., March 1, 2002; 4(suppl_C): C39 - C47. [Abstract] [PDF]
|
|
|
|
|
|
S. H. Rezkalla and R. A. Kloner No-Reflow Phenomenon Circulation, February 5, 2002; 105(5): 656 - 662. [Full Text] [PDF]
|
|
|
|
|
|
T. Reffelmann and R. A Kloner The "no-reflow" phenomenon: basic science and clinical correlates Heart, February 1, 2002; 87(2): 162 - 168. [Full Text] [PDF]
|
|
|
|
|
|
B. G. Angeja, M. Gunda, S. A. Murphy, B. E. Sobel, A. C. Rundle, M. Syed, A. Asfour, S. Borzak, S. G. Gourlay, H. V. Barron, et al. TIMI Myocardial Perfusion Grade and ST Segment Resolution: Association With Infarct Size as Assessed by Single Photon Emission Computed Tomography Imaging Circulation, January 22, 2002; 105(3): 282 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Barrabes, D. Garcia-Dorado, M. Mirabet, R.-M. Lidon, B. Soriano, M. Ruiz-Meana, P. Pizcueta, J. Blanco, Y. Puigfel, and J. Soler-Soler Lack of effect of glycoprotein IIb/IIIa blockade on myocardial platelet or polymorphonuclear leukocyte accumulation and on infarct size after transient coronary occlusion in pigs J. Am. Coll. Cardiol., January 2, 2002; 39(1): 157 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sciagra, S. Sestini, L. Bolognese, G. Cerisano, P. Buonamici, and A. Pupi Comparison of Dobutamine Echocardiography and 99mTc-Sestamibi Tomography for Prediction of Left Ventricular Ejection Fraction Outcome After Acute Myocardial Infarction Treated with Successful Primary Coronary Angioplasty J. Nucl. Med., January 1, 2002; 43(1): 8 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yamamoto, H. Ito, K. Iwakura, Y. Shintani, T. Masuyama, M. Hori, S. Kawano, Y. Higashino, and K. Fujii Pressure-derived collateral flow index as a parameter of microvascular dysfunction in acute myocardial infarction J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1383 - 1389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. KAUL Coronary angiography cannot be used to assess myocardial perfusion in patients undergoing reperfusion for acute myocardial infarction Heart, November 1, 2001; 86(5): 483 - 484. [Full Text] [PDF]
|
|
|
|
|
|
M. A APPLEBY, B. G ANGEJA, K. DAUTERMAN, and C M. GIBSON Angiographic assessment of myocardial perfusion: TIMI myocardial perfusion (TMP) grading system Heart, November 1, 2001; 86(5): 485 - 486. [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Armstrong New advances in the management of acute coronary syndromes: 2. Fibrinolytic therapy for acute ST-segment elevation myocardial infarction Can. Med. Assoc. J., September 1, 2001; 165(6): 791 - 797. [Full Text] [PDF]
|
|
|
|
|
|
E. Giannitsis, M. Muller-Bardorff, S. Lehrke, U. Wiegand, R. Tolg, B. Weidtmann, F. Hartmann, G. Richardt, and H. A. Katus Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction Circulation, August 7, 2001; 104(6): 630 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. A. Swinburn, A. Lahiri, and R. Senior Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction J. Am. Coll. Cardiol., July 1, 2001; 38(1): 19 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Armstrong and D. Collen Fibrinolysis for Acute Myocardial Infarction : Current Status and New Horizons for Pharmacological Reperfusion, Part 1 Circulation, June 12, 2001; 103(23): 2862 - 2866. [Full Text] [PDF]
|
|
|
|
|
|
F. Van de Werf New aspects of pharmacological reperfusion: from macro- to microlysis Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C62 - C68. [Abstract] [PDF]
|
|
|
|
|
|
A.M. Antman, J.A. de Lemos, and E. Braunwald Epicardial flow and myocardial reperfusion following abciximab and low-dose thrombolytic therapy for acute myocardial infarction Eur. Heart J. Suppl., May 1, 2001; 3(suppl_A): A8 - A13. [Abstract] [PDF]
|
|
|
|
|
|
F.-J. Neumann Optimization of microvascular reperfusion in acute myocardial infarction Eur. Heart J. Suppl., May 1, 2001; 3(suppl_A): A21 - A25. [Abstract] [PDF]
|
|
|
|
|
|
M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion J. Am. Coll. Cardiol., January 1, 2001; 37(1): 9 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Morishima, T. Sone, K. Okumura, H. Tsuboi, J. Kondo, H. Mukawa, H. Matsui, Y. Toki, T. Ito, and T. Hayakawa Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1202 - 1209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Akasaka, K. Yoshida, T. Kawamoto, S. Kaji, Y |