ST-segment resolution after reperfusion therapy is a reliable, noninvasive predictor of mortality. ST-segment resolution appears to reflect restoration of myocardial tissue perfusion, not just epicardial flow [11]. Rapid ST-segment resolution within 30-60 min if primary PCI (patent IRA with TIMI grade 3 flow) is successful predicts greater improvement in ejection fraction, reduced infarct size, and improved survival as compared with delayed ST-segment resolution [12,13], However, there have been few studies that have evaluated the relation between ST-segment resolution analysis and the microvascular condition of the reperfused myocardium. More recently studies have used echocardiograpic WMSI as a marker for left ventricle dysfunction. Echocardiograpic WMSI is a relatively easily obtained marker of global left ventricle dysfunction after myocardial infarction [14]. It is derived by grading the wall motion of individual myocardial segments and dividing the total score by the number of analyzable segments.
Although improved epicardial blood flow has been related to reduced mortality after administration of PCI, many cardiologists have focused on microvascular reperfusion of infarcted myocardium as a final goal of reperfusion therapy [15-18]. In this study, we chose an ST-segment analysis and assessed ST-segment changes and CTFC to derive a simple and inexpensive tool for identification of impaired myocardial reperfusion. As a result, we found that the CTFC fast group had a higher ratio of complete ST resolution than the CTFC slow group and lower ratio of no ST resolution than the CTFC slow group. We also found that the change in WMSI (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group and there was a significant negative correlation between ∆WMSI and CTFC.
The CTFC and ST resolution may provide additional information about the degree of microcirculatory damage in patients with TIMI grade 3 flow reperfused AMI, so they may enable identification of patients who would benefit from additional pharmacological adjunctive treatment, which attenuates microvascular dysfunction and augments myocardial blood flow in the reperfused myocardium, such as verapamil and adenosine [19-21]. Patients with both normal epicardial flow (TIMI grade 3 flow) and normal tissue-level perfusion (CTFC low and complete ST-segment-elevation resolution) would have greater functional recovery and lower incidence of complications in the convalescent stage [4,22]
CONCLUSIÓN
Among patients with acute ST-segment elevation myocardial infarction successfully treated by primary angioplasty, CTFC combined with ST-segment resolution may provide complementary information in the evaluation of myocardial perfusion and give additional prognostic information.
Although improved epicardial blood flow has been related to reduced mortality after administration of PCI, many cardiologists have focused on microvascular reperfusion of infarcted myocardium as a final goal of reperfusion therapy [15-18]. In this study, we chose an ST-segment analysis and assessed ST-segment changes and CTFC to derive a simple and inexpensive tool for identification of impaired myocardial reperfusion. As a result, we found that the CTFC fast group had a higher ratio of complete ST resolution than the CTFC slow group and lower ratio of no ST resolution than the CTFC slow group. We also found that the change in WMSI (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group and there was a significant negative correlation between ∆WMSI and CTFC.
The CTFC and ST resolution may provide additional information about the degree of microcirculatory damage in patients with TIMI grade 3 flow reperfused AMI, so they may enable identification of patients who would benefit from additional pharmacological adjunctive treatment, which attenuates microvascular dysfunction and augments myocardial blood flow in the reperfused myocardium, such as verapamil and adenosine [19-21]. Patients with both normal epicardial flow (TIMI grade 3 flow) and normal tissue-level perfusion (CTFC low and complete ST-segment-elevation resolution) would have greater functional recovery and lower incidence of complications in the convalescent stage [4,22]
CONCLUSIÓN
Among patients with acute ST-segment elevation myocardial infarction successfully treated by primary angioplasty, CTFC combined with ST-segment resolution may provide complementary information in the evaluation of myocardial perfusion and give additional prognostic information.
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