Page 32 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Chapter 2
(IRA). All patients gave informed consent to the study before the procedure. The institutional review board had approved the study protocol.
Primary angioplasty and Doppler flow measurements
Primary PCI was performed within 6 h after the onset of symptoms via 6F sheath in the femoral artery, according to standard clinical practice with provisional stent implantation. Coronary angiography was performed at the end of PCI for off-line flow analyses. Five to 10 min after successful PCI, blood flow velocity was measured with a 0.014 inch Doppler wire (FloWire, Jomed, Ulestraten, The Netherlands) distal to the lesion. Coronary flow velocity reserve was determined as the ratio of adenosine (20 μg intracoronary), induced hyperemic average peak flow velocity (APV), and baseline APV. Flow velocities were recorded continuously on videotape (FloMap, Jomed). Coronary flow velocity reserve was also measured in an angiographically normal (diameter stenosis <30%) reference artery at the end of the procedure. A 12-lead ECG was performed before and at the end of PCI to evaluate ST-segment deviation.
Concomitant medical therapy
All patients were treated with aspirin 300 mg orally and heparin 5,000 IU intravenously before the procedure. An additional 2,500 IU heparin intravenously was administered if the procedure lasted more than 90 min. According to the protocol, patients subsequently received unfractionated heparin for 48 h, aspirin 100 mg daily, and ticlopidine 250 mg or clopidogrel 75 mg once daily after stent placement. Captopril was administered within 24 h after PCI and uptitrated if possible to 25 mg three times a day, metoprolol 50 mg twice a day, uptitrated if possible. Statin treatment was started the day after admission irrespective of serum cholesterol values.
LV function evaluation and follow-up
Two-dimensional echocardiography was performed immediately before primary PCI with a commercially available imaging system (Philips SONOS 2500, 2.0/2.5 MHz transducer). Data was stored on videotape. Echocardiographic evaluation of the LV function was repeated at day one, at one week, and at six months follow-up. After five weeks, a gated radionuclide ventriculography was performed. At six months follow-up, coronary angiography was repeated to assess vessel patency and/or restenosis. At six months, all patients were
30