CLINICAL STUDIES
Prediction of short- and intermediate-term prognoses of patients with acute myocardial infarction using myocardial contrast echocardiography one day after recanalization
Tadamichi Sakuma, MDa,
Yasuhiko Hayashi, MDa,
Kotaro Sumii, MD*,
Michinori Imazu, MD* and
Michio Yamakido, MD*
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.
|
Abbreviations and Acronyms
| | CABG | = coronary artery bypass surgery | | ECGs | = electrocardiograms | | IRA | = infarct-related coronary artery | | LAD | = left anterior descending coronary artery | | MCE | = myocardial contrast echocardiography | | MI | = myocardial infarction | | RA | = risk area | | PGSR | = peak gray scale ratio | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = Thrombolysis In Myocardial Infarction Trial |
|
This article has been cited by other articles:
|
|
|
|
 
S. T. Laing and D. D. McPherson
Cardiovascular therapeutic uses of targeted ultrasound contrast agents
Cardiovasc Res,
July 6, 2009;
(2009)
cvp192v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kaul
Myocardial Contrast Echocardiography: A 25-Year Retrospective
Circulation,
July 15, 2008;
118(3):
291 - 308.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Hayat and R. Senior
Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time?
Eur. Heart J.,
February 1, 2008;
29(3):
299 - 314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sezer, I. Okcular, T. Goren, H. Oflaz, Y. Nisanci, B. Umman, F. Mercanoglu, A. K Bilge, M. Meric, and S. Umman
Association of haematological indices with the degree of microvascular injury in patients with acute anterior wall myocardial infarction treated with primary percutaneous coronary intervention
Heart,
March 1, 2007;
93(3):
313 - 318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. A. Centurion
The Open Artery Hypothesis: Beneficial Effects and Long-term Prognostic Importance of Patency of the Infarct-Related Coronary Artery
Angiology,
February 1, 2007;
58(1):
34 - 44.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P. A. Dijkmans, R. Senior, H. Becher, T. R. Porter, K. Wei, C. A. Visser, and O. Kamp
Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion: The Evidence So Far
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2168 - 2177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Mariani, R. Fetiveau, E. Rossetti, A. Poli, F. Poletti, P. Vandoni, M. D'Urbano, F. Cafiero, G. Mariani, C. Klersy, et al.
Significance of total and differential leucocyte count in patients with acute myocardial infarction treated with primary coronary angioplasty
Eur. Heart J.,
November 1, 2006;
27(21):
2511 - 2515.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Silva-Orrego, P. Colombo, R. Bigi, D. Gregori, A. Delgado, P. Salvade, J. Oreglia, P. Orrico, A. de Biase, G. Piccalo, et al.
Thrombus Aspiration Before Primary Angioplasty Improves Myocardial Reperfusion in Acute Myocardial Infarction: The DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) Study
J. Am. Coll. Cardiol.,
October 17, 2006;
48(8):
1552 - 1559.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Kirtane, J. J. Vafai, S. A. Murphy, J. M. Aroesty, M. S. Sabatine, C. P. Cannon, C. M. Gibson, and for the TIMI Study Group
Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy
Eur. Heart J.,
September 1, 2006;
27(17):
2040 - 2045.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Kato, K Dote, S Sasaki, K Goto, H Takemoto, S Habara, and D Hasegawa
Myocardial performance index for assessment of left ventricular outcome in successfully recanalised anterior myocardial infarction
Heart,
May 1, 2005;
91(5):
583 - 588.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, B. J. Gersh, C. Costantini, M. G. McLaughlin, P. Zimetbaum, D. A. Cox, E. Garcia, J. E. Tcheng, R. Mehran, A. J. Lansky, et al.
Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction
Eur. Heart J.,
April 1, 2005;
26(7):
667 - 674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, N. Carrabba, G. Parodi, G. M. Santoro, P. Buonamici, G. Cerisano, and D. Antoniucci
Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction
Circulation,
March 9, 2004;
109(9):
1121 - 1126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kaul and H. Ito
Microvasculature in Acute Myocardial Ischemia: Part II: Evolving Concepts in Pathophysiology, Diagnosis, and Treatment
Circulation,
January 27, 2004;
109(3):
310 - 315.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Nishino, H.-J. Youn, D. Gheorghevici, C. Zellner, T. M. Chou, K. Sudhir, and R. F. Redberg
Effect of Intracoronary Estradiol on Postischemic Microvascular Damage in a Porcine Model: A Myocardial Contrast Echocardiographic Study
Angiology,
November 1, 2003;
54(6):
701 - 709.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L Galiuto, A Lombardo, A Maseri, L Santoro, I Porto, D Cianflone, A G Rebuzzi, and F Crea
Temporal evolution and functional outcome of no reflow: sustained and spontaneously reversible patterns following successful coronary recanalisation
Heart,
July 1, 2003;
89(7):
731 - 737.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-K. Wong, J.K. French, M.W. Krucoff, W. Gao, P.E. Aylward, and H.D. White
Slowed ST segment recovery despite early infarct artery patency in patients with Q waves at presentation with a first acute myocardial infarction. Implications of initial Q waves on myocyte reperfusion
Eur. Heart J.,
September 2, 2002;
23(18):
1449 - 1455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Poli, R. Fetiveau, P. Vandoni, G. del Rosso, M. D'Urbano, G. Seveso, F. Cafiero, and S. De Servi
Integrated Analysis of Myocardial Blush and ST-Segment Elevation Recovery After Successful Primary Angioplasty: Real-Time Grading of Microvascular Reperfusion and Prediction of Early and Late Recovery of Left Ventricular Function
Circulation,
July 16, 2002;
106(3):
313 - 318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. J. Goswami, J. M. Moody Jr, and S. R. Bailey
Percutaneous Mechanical Reperfusion During Acute Myocardial Infarction
J Intensive Care Med,
July 1, 2002;
17(4):
162 - 173.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E.M. Antman, H.A. Cooper, C.M. Gibson, J.A. de Lemos, C.H. McCabe, R.P. Giugliano, P. Coussement, S. Murphy, J. Scherer, K. Anderson, et al.
Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction. Insights from TIMI 14 and InTIME-II
Eur. Heart J.,
June 2, 2002;
23(12):
928 - 933.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Agati, S. Funaro, M. Madonna, C. Volponi, G. Veneroso, and G. Tonti
Clinical utility of contrast echocardiography in the management of patients with acute myocardial infarction
Eur. Heart J. Suppl.,
March 1, 2002;
4(suppl_C):
C27 - C34.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Distante, R. Dankowski, P. Mincarone, C.G. Leo, E. Gianicolo, P. Voci, M.A. Morales, and D. Rovai
Contrast echocardiography and medical economics: looking into the crystal ball
Eur. Heart J. Suppl.,
March 1, 2002;
4(suppl_C):
C39 - C47.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Reffelmann and R. A Kloner
The "no-reflow" phenomenon: basic science and clinical correlates
Heart,
February 1, 2002;
87(2):
162 - 168.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Giannitsis, M. Muller-Bardorff, S. Lehrke, U. Wiegand, R. Tolg, B. Weidtmann, F. Hartmann, G. Richardt, and H. A. Katus
Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction
Circulation,
August 7, 2001;
104(6):
630 - 635.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff
Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion
J. Am. Coll. Cardiol.,
January 1, 2001;
37(1):
9 - 18.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Giannitsis, S. Lehrke, U. K. H. Wiegand, V. Kurowski, M. Muller-Bardorff, B. Weidtmann, G. Richardt, and H. A. Katus
Risk Stratification in Patients With Inferior Acute Myocardial Infarction Treated by Percutaneous Coronary Interventions : The Role of Admission Troponin T
Circulation,
October 24, 2000;
102(17):
2038 - 2044.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Gibson, C. P. Cannon, S. A. Murphy, K. A. Ryan, R. Mesley, S. J. Marble, C. H. McCabe, F. Van de Werf, and E. Braunwald
Relationship of TIMI Myocardial Perfusion Grade to Mortality After Administration of Thrombolytic Drugs
Circulation,
January 18, 2000;
101(2):
125 - 130.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Gibson, C. P. Cannon, S. A. Murphy, S. J. Marble, H. V. Barron, E. Braunwald, and for the TIMI Study Group
Relationship of the TIMI Myocardial Perfusion Grades, Flow Grades, Frame Count, and Percutaneous Coronary Intervention to Long-Term Outcomes After Thrombolytic Administration in Acute Myocardial Infarction
Circulation,
April 23, 2002;
105(16):
1909 - 1913.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
