Page 41 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Table 5. Multivariate Predictors of Recovery of Regional Left Ventricular Function*
Coefficient
Recovery at one day
Constant -0.44 Regional WMI before PCI ≥2.4 0.18 Single-vessel disease 0.17
Early systolic retrograde flow velocity <10cm/s Recovery at one week
95% CI
0.06-0.29 0.03-0.31 0.40-0.29
-0.07-0.47 0.08-0.61 0.08-0.41 0.07-0.46 0.04-0.39
0.14-0.41
p Value
0.004 0.016 0.011
0.148 0.012 0.004 0.008 0.015
<0.0001
2
0.16 Constant -0.47
Aspirin use
Statin use
Regional WMI before PCI ≥2.4
Single-vessel disease
Early systolic retrograde flow velocity <10cm/s
0.20 0.34 0.25 0.27 0.22
Recovery at six months
Constant -0.02
CFR after PCI
0.28
Prediction of recovery of LV function
*Recovery defined as WMI before PCI minus WMI at specific time points. CFR = coronary flow velocity reserve; CI = confidence interval; PCI = percutaneous coronary intervention; WMI = Wall Motion Index.
Discussion
In our homogenously selected group of patients with a first anterior acute MI, Doppler-derived CFR obtained directly after primary PCI was the only independent predictor of long-term global and regional recovery of LV function. Thrombolysis In Myocardial Infarction flow grading predicted global recovery of LV function at one week, but not at other time points. No other angiographic parameter after primary PCI predicted LV function recovery. To our knowledge, this is the first study that directly compared CFR with other prognostic variables for LV function recovery at six months after primary PCI.
ST-segment resolution and LV function recovery
In contrast with earlier studies,14,18,19 we could not demonstrate a relation between ST-segment recovery and ejection fraction nor between ST-segment recovery and improvement of LV function. Our results are in accordance with the results of Poli et al. as they found, with respect to six-month functional recovery, no additional prediction of ST-segment resolution next to myocardial blush grade.19 ST-segment resolution is proposed as a marker of microvascular reperfusion.20 However, in our study, no relation existed between ST- segment resolution and CFR, although it was associated with baseline and hyperemic
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