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J Am Coll Cardiol, 1998; 32:890-897 © 1998 by the American College of Cardiology Foundation |
a Division of Cardiology, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
* The Second Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan
Manuscript received May 21, 1997; revised manuscript received May 27, 1998, accepted June 12, 1998.
Address for correspondence: Dr. Tadamichi Sakuma, Division of Cardiology, Akane Foundation Tsuchiya General Hospital, 3-30 Nakajima, Naka-ku, Hiroshima, 730-8655 Japan
sakuma{at}urban.ne.jp
Objectives. This study sought to determine whether microvascular integrity in the risk area (RA) for myocardial infarction (MI) one day after recanalization predicts the outcome in patients with first acute MI.
Background. Immediately after recanalization, microcirculation in the RA is modified by both hyperemic response and microvascular impairment.
Methods. Fifty consecutive patients who underwent serial myocardial contrast echocardiography before and one day after recanalization (day 2) were studied. All patients had a completely occluded lesion in the left anterior descending coronary artery alone, and underwent successful reperfusion therapy. The relative size of the initial RA (RA ratio) and peak gray scale ratio (PGSR) within the RA on day 2 were determined. Patients were followed for a median of 22 months to evaluate clinical outcome.
Results. On day 2, PGSR was a median of 0.46. Study patients were subdivided into two groups, group A of 24 patients with acceptable opacification (PGSR > 0.46 on day 2) and group B of 26 patients without it. Major cardiac events (cardiac death, nonfatal MI and repeat admission for congestive heart failure) were more frequently observed in group B (28% vs. 4%, Cox hazard ratio = 8.5, p = 0.05, 95% confidence interval [CI] 1.03 to 69.9). The median value of the RA ratio was 0.45. Patients (n = 15) with RA ratio > 0.45 on day 1 and PGSR on day 2 
0.46 exhibited a 10.7-fold relative risk for major cardiac events (p = 0.005, 95% CI 2.06 to 55.8) and a 3.69-fold relative risk for composite cardiac events (major cardiac events and target lesion revascularizations) after the initial intervention (p = 0.004, 95% CI 1.51 to 9.04).
Conclusions. The assessment of both the size of the initial RA and microvascular integrity on day 2 enables precise determination of the efficacy of reperfusion therapy and prediction of the short- and intermediate-term prognoses of patients with recanalized MI.
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