Abstract:
BACKGROUND:Incomplete ST-segment resolution (STR) after successful primary angioplasty for acute myocardial infarction (AMI) is associated with a poor prognosis. We used intracoronary Doppler velocimetry to investigate whether incomplete STR after primary angioplasty is a marker of severe microcirculatory dysfunction. METHODS AND RESULTS:Fifty patients with < or =12-hour AMI underwent successful primary angioplasty and systematic stenting with a Doppler guidewire. Patients with incomplete (<50%) STR 60 minutes after TIMI 3 flow was restored had flow velocity features suggestive of severe microcirculatory dysfunction, including a higher incidence of early systolic retrograde flow (41% versus 9%, P=0.007) and lower coronary flow velocity reserve (CVR, 1.3 versus 1.6, P<0.001). CVR improved immediately after stenting in patients with > or =50% STR but not in patients with <50% STR. There was a significant correlation between STR and poststent CVR. At 3 months, CVR was similar in patients with <50% and > or =50% STR. However, left ventriculography indicated lower global (42% versus 55%, P=0.001) and regional (16% versus 20%, P=0.03) left ventricular ejection fractions and 201Tl rest-redistribution scintigraphy indicated a larger infarct size (34% versus 16% 201Tl defect, P=0.007) in patients with <50% STR. CONCLUSIONS:After successful primary angioplasty with systematic stenting, <50% STR is a marker of severe albeit transient microcirculatory dysfunction in patients with AMI and is associated with more extensive myocardial damage.
journal_name
Circulationjournal_title
Circulationauthors
Feldman LJ,Coste P,Furber A,Dupouy P,Slama MS,Monassier JP,Tron C,Lafont A,Faraggi M,Le Guludec D,Dubois-Randé JL,Steg PG,FRench Optimal STenting-2 Invest.doi
10.1161/01.CIR.0000070423.91346.45subject
Has Abstractpub_date
2003-06-03 00:00:00pages
2684-9issue
21eissn
0009-7322issn
1524-4539pii
01.CIR.0000070423.91346.45journal_volume
107pub_type
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