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Title of article :
Association of a pulsatile blood flow pattern on coronary arteriography and short-term clinical outcomes in acute myocardial infarction Original Research Article
Author/Authors :
C.Michael Gibson، نويسنده , , Juhana Karha، نويسنده , , Sabina A Murphy، نويسنده , , James A de Lemos، نويسنده , , David A Morrow، نويسنده , , Robert P. Giugliano، نويسنده , , Mathew T Roe، نويسنده , , Robert A Harrington، نويسنده , , Christopher P Cannon، نويسنده , , Elliott M Antman، نويسنده , , Robert M. Califf، نويسنده , , Eugene Braunwald and TIMI Study Group، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2004
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Abstract :
Objectives We hypothesized that recognition of systolic flow reversal (pulsatile flow) after thrombolytic administration on coronary angiography is associated with angiographic and electrocardiogram findings reflecting impaired myocardial perfusion, as well as poorer clinical outcomes. Background Reversal of systolic flow on Doppler velocity wire recordings has been associated with impaired tissue perfusion on myocardial contrast echocardiography in the setting of myocardial infarction (MI). Methods Patients (n = 1,062) with a patent infarct-related artery were drawn from the Thrombolysis In Myocardial Infarction (TIMI) 10, TIMI 14, and Integrillin and Tenecteplase acute MI trials. Results Pulsatile flow (systolic flow reversal with cessation of antegrade contrast-dye motion or frank reversal of contrast-dye motion during systole) at 60 min after fibrinolytic administration was present in 11.0% of patients. Pulsatile flow was associated with higher corrected TIMI frame counts (slower epicardial flow) (median 40.1 frames, IQ 30 of 63 vs. 30 frames, interquartile 22 of 42, p < 0.0001), a closed microvasculature (TIMI myocardial perfusion grades 0 of 1, 57.1% vs. 37.8%, p = 0.03) and less complete (≥70%) ST-segment resolution (23.5% vs. 58.9%, p = 0.008). Patients with pulsatile flow had a higher risk of death or reinfarction at 30 days (10.3% vs. 5.0%, p = 0.019). After controlling for age, pulse, blood pressure, anterior MI location, epicardial flow, and creatine kinase, pulsatile flow remained associated with an increased risk of death/MI (odds ratio 3.1, p = 0.006). Conclusions A pulsatile pattern of flow is associated with impaired myocardial perfusion and poorer clinical outcomes independent of the velocity of antegrade flow in the epicardial artery. This simple and easily identifiable angiographic flow pattern may be useful in clinical risk stratification.
Keywords :
PCI , LAD , Percutaneous coronary intervention , TIMI , Thrombolysis In Myocardial Infarction , corrected TIMI frame count , CTFC , INTEGRITI , STEMI , TMPG , left anterior descending artery , Integrillin and Tenecteplase in Acute Myocardial Infarction trial , ST-elevation myocardial infarction , TFG , TIMI flow grade , TIMI myocardial perfusion grade , TNK , tenecteplase
Journal title :
JACC (Journal of the American College of Cardiology)
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