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

December 10, 2004

By Ashley Starkweather, B.S. and Asher Kimchi M.D.

Angers, France - Doppler guidewire assessment of coronary flow velocity (CFV) in recanalized infarct-related coronary artery has long-term prognostic value for fatal and nonfatal cardiac events. This article published by Alain P. Furber M.D., PhD., et. al, from the Department of Cardiology of Angers University Hospital in Angers, France shows that average peak velocity (APV) <10cm/s and average systolic peak velocity (ASPV) < 5cm/s were associated with a significantly higher risk of CHF and of reaching the combined end point (cardiac death and or reinfarction and/or CHF). Both in-hospital and long-term adverse clinical events can be predicted by the CFV pattern immediately after primary and rescue PRCA, establishing a relationship between the risk of adverse clinical events and microcirculatory function measured by intracoronary Doppler examination. 

Analysis of CFV in the recanalized infarct-related coronary artery (IRA) has been shown useful for predicting recovery of regional left ventricular function, in-hospital complications and survival. This article postulated that the CFV pattern after IRA reperfusion for acute myocardial infarction (AMI) would predict long-term adverse cardiac events.  

Sixty-eight consecutive patients underwent direct or rescue coronary angioplasty within 6 to 24 hours after chest pain. At the end of the angioplasty procedure, CFVs were recorded with the Doppler guidewire that had been positioned with a tracking catheter. APV (the time-averaged peak velocity normalized to the cardiac cycle, which is the time average of the spectral peak velocity waveform of 2 cardiac cycles) and ASPV (average systolic peak velocity) were significantly lower in patients with cardiac events than in the other patients. APV values were 12.1 +/- 8.1cm/s in patients with cardiac events versus 18.8 +/- 9.0 cm/s in other patients (P=0.014.) ASPV values were 6.0 +/- 4.2 cm/s in patients with cardiac events and 10.9 +/- 6.4 cm/s (P=0.002). APV > 10 cm/s and ASPV > 5 cm/s were associated with a significantly lower risk of CHF and of reaching the combined end point of cardiac death, reinfarction and/or CHF.  

Twenty patients had early retrograde systolic flow and 31 patients had a rapid deceleration in diastole. Patients with early retrograde systolic flow had an increased risk of cardiac death (P=0.02) and CHF (not statistically significant) during the entire follow-up period, whereas patients with a rapid diastolic deceleration time had an increased risk of CHF (P=0.09). 

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 creatinine kinase >4000 IU/L, ejection fraction < 50%, proximal left anterior descending artery occlusion, resting peak velocity <10cm/s, average systolic peak velocity < 5 cm/s, a rapid diastolic deceleration time and early retrograde systolic flow. 

Co-authors: Alain P. Furber, M.D, PhD; Fabrice Prunier, M.D.; Hoang Cuong Phan Nguyen, M.D.; Stephane Boulet, M.D.; Stephane Delepine, M.D; Philippe Geslin, M.D. 

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