Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

OBJECTIVES The purpose of this study was to examine the relationship betwee n the pattern of coronary blood flow velocity immediately after successful primary stenting and the recovery of left ventricular (LV) wall motion in p atients with acute myocardial infarction (AMI). BACKGROUND It is difficult to predict the recovery of LV wall motion immedi ately after direct angioplasty in AMI. Recent reports indicate that dysfunc tional coronary microcirculation is an important determinant of prognosis f or AMI patients after successful reperfusion. METHODS We measured left anterior descending coronary flow velocity variabl es using a Doppler guide wire immediately after successful primary stenting in 31 patients with their first anterior AMI. The patients were divided in to two groups: those with and those without early systolic reverse flow (ES RF). Changes in LV regional wall motion (RWM) and ejection fraction (EF) at admission and at discharge were compared between the two groups. Coronary flow velocity variables immediately after primary stenting were compared wi th changes in left ventriculographic indexes. RESULTS The change in RWM was significantly greater in the non-ESRF group t han it was in the ESRF group (0.9 +/- 0.7 vs. -0.1 +/- 0.3 standard deviati on/chord, respectively, p < 0.001). The change in EF was also significantly greater in the non-ESRF group than it was in the ESRF group (10 +/- 10 vs. 1 +/- 6%, respectively, p < 0.05). In the non ESRF group (diastolic to sys tolic velocity ratio [DSVR] <3.0), the DSVR correlated positively with the change in RWM (r = 0.60, p < 0.005, n = 24) and the change in EF (r = 0.52, p < 0.01). CONCLUSIONS The coronary flow velocity pattern measured immediately after s uccessful primary stenting is predictive of the recovery of regional and gl obal LV function in patients with AMI. (J Am Coll Cardiol 2000;35:1835-41) (C) 2000 by the American College of Cardiology.