Abstract 2513: Assessment of Both Coronary Microvascular Damage and Epicardial Flow Velocity Measurement Immediately after Successful Percutaneous Coronary Intervention for Acute Myocardial Infarction Predicts In-Hospital Complications and Survival

Abstract

Quantitative measurement of post-reperfusion epicardial flow velocity by a Doppler guidewire can predict clinical cardiac events in patients with acute myocardial infarction (AMI). It has also been reported that the coronary flow velocity pattern in patients with microvascular dysfunction 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). Two hundred and eleven consecutive patients with first anterior AMI who underwent successful PCI were subjected to coronary flow measurement immediately after successful PCI 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 dysfunction 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 dysfunction (group 1, n=122), with microvascular dysfunction and normal epicardial flow (group 2, n= 54), with microvascular dysfunction and slow epicardial flow (group 3, n=35). The clinical event rate was compared among the 3 groups. The in-hospital event rates for congestive heart failure, cardiac rupture and death were highest in group 3 and lowest in group 1 (Table ). Assessment of both coronary microvascular damage and epicardial flow velocity can accurately predict in-hospital complications and survival in AMI patients who underwent successful reperfusion of the infarct-related coronary artery, identifying a subset of high risk patients. In-hospital event rates (%)