Page 50 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax

Chapter 3
flow dynamics and resistance has not been described in a homogenous group of patients. This study examined the coronary hemodynamics of IRAs and non-IRAs in the acute phase and at short- and long-term follow-up in patients who were treated with primary percutaneous intervention for a first anterior wall AMI.
Methods
Patient selection
We studied 100 consecutive patients who presented with a first anterior wall AMI that was treated with primary angioplasty. AMI was defined as chest pain that lasted >30 minutes in conjunction with persistent ST-segment elevation ≥2 mV in 2 adjacent precordial leads. Exclusion criteria were cardiogenic shock (systolic blood pressure <90 mm Hg despite conservative measurements), previous AMI, previous coronary artery bypass surgery, previous left ventricular ejection fraction <40%, acute left-side heart failure (Killip’s class >II), left ventricular hypertrophy (interventricular septum or posterior wall ≥12 mm), diffuse coronary artery disease, or 3-vessel disease. All patients gave informed consent to the study before the procedure. An institutional review board approved the study protocol. The investigation conformed with principles outlined in the Declaration of Helsinki.
Coronary angiography
Coronary angiography was performed within 6 hours after onset of symptoms through a 6Fr sheath in the femoral artery. Patients were excluded if there was 3-vessel disease with >30% diameter stenosis, Thrombolysis In Myocardial Infarction grade 2 or 3 flow in an IRA at initial angiography, or unsuccessful percutaneous coronary intervention (no anterograde flow and/or >50% residual stenosis). Systolic and diastolic blood pressures at the tip of the guiding catheter and heart rate were recorded continuously. Coronary angiography was repeated at 1-week and 6-month follow-up.
Primary angioplasty and Doppler flow measurements
Primary angioplasty was performed according to standard clinical practice. Stent implantation was at the discretion of the operator. A stent was implanted in 68% of patients. Five to 10 minutes after successful angioplasty, blood
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