Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction
Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction
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经皮冠状动脉介入治疗后立即的冠状动脉血流速度模式作为急性心肌梗死后并发症和院内生存的预测因子
作者：
A. Yamamuro;T. Akasaka;Koichi Tamita;K. Yamabe;M. Katayama;T. Takagi;S. Morioka
背景——最近，有报道称，根据使用多普勒导丝评估的冠状动脉血流速度（CFV）模式，可以预测梗死相关动脉治疗后慢性期的微血管损伤程度和左心室功能恢复。这项前瞻性研究的目的是检查 CFV 模式是否可以预测急性心肌梗死 (AMI) 后的并发症和院内生存率。方法和结果——研究人群由 169 名连续患有首次前壁 AMI 且经皮冠状动脉介入治疗 (PCI) 成功治疗的患者组成。 PCI 后我们立即使用多普勒导丝检查了 CFV 模式。根据之前的研究结果，我们将严重微血管损伤定义为舒张期减速时间≤600 ms并且存在收缩期血流逆转。患者被分为两组：无严重微血管损伤的患者（n=118；第1组）和有严重微血管损伤的患者（n=51；第2组）。所有发生心脏破裂的患者均属于第 2 组。第 2 组中观察到充血性心力衰竭 (CHF) 的频率高于第 1 组（53% 对比 8%，P <0.001）。第 2 组的院内心脏死亡率显着高于第 1 组（18% vs 0%，P <0.001）。第2组中有9名患者死亡，其中5名患者死于CHF，4名患者死于心脏破裂。结论——这些研究结果表明，CFV 模式可以准确预测 AMI 后是否存在并发症以及院内生存率。
Background—Recently, it was reported that the degree of microvascular injury and left ventricular functional recovery during the chronic period can be predicted after treatment of the infarct-related artery based on the coronary flow velocity (CFV) pattern assessed using a Doppler guidewire. The aim of this prospective study was to examine whether the CFV pattern may predict complications and in-hospital survival after acute myocardial infarction (AMI). Methods and Results—The study population consisted of 169 consecutive patients with a first anterior AMI successfully treated with percutaneous coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. In accordance with previous findings, we defined severe microvascular injury as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascular injury (n=118; group 1) and those with severe microvascular injury (n=51; group 2). All of the patients who had cardiac rupture were in group 2. Congestive heart failure (CHF) was observed more frequently in group 2 than in group 1 (53% versus 8%, P <0.001). The in-hospital cardiac mortality rate was significantly higher in group 2 than in group 1 (18% versus 0%, P <0.001). Nine patients in group 2 died, 5 patients because of CHF and 4 patients because of cardiac rupture. Conclusions—These findings suggest that the CFV pattern is an accurate predictor of the presence or absence of complications and of in-hospital survival after AMI.