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CLINICAL STUDY: ACUTE CORONARY SYNDROMES

Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction

Insight into mechanisms of microvascular dysfunction

Koichi Yamamoto, MD^*, Hiroshi Ito, MD, FACC^*,*, Katsuomi Iwakura, MD^*, Shigeo Kawano, MD^*, Masashi Ikushima, MD^*, Tohru Masuyama, MD, FACC, Toshio Ogihara, MD and Kenshi Fujii, MD^*

^* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
Department of Internal Medicine and Therapeutics, Graduate School of Medicine, Osaka University, Osaka, Japan
Department of Geriatric Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

Manuscript received April 12, 2002; revised manuscript received June 14, 2002, accepted July 17, 2002.

^* Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
itomd{at}osk4.3web.ne.jp

OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI).

BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown.

METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE).

RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. –0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10%) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91% vs. 14%, p < 0.05).

CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.

Abbreviations and Acronyms   AMI   acute myocardial infarction   APV   average peak velocity   CBFV   coronary blood flow velocity   ICT   intracoronary thrombus   MCE   myocardial contrast echocardiography   PCI   percutaneous coronary intervention   SFR   systolic flow reversal   TIMI   Thrombolysis In Myocardial Infarction   TIMI-2/3 flow   Thrombolysis In Myocardial Infarction flow grade 2/3

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