CLINICAL STUDY
Coronary recanalization in anterior myocardial infarction
The open perforator hypothesis1
Paolo Voci, MD, PhD*,*,
Enrica Mariano, MD*,
Francesco Pizzuto, MD*,
Paolo Emilio Puddu, MD, FESC, FACC* and
Francesco Romeo, MD, FESC, FACC
* Section of Cardiology, La Sapienza University, Rome, Italy
Section of Cardiology, Tor Vergata University, Rome, Italy
Manuscript received January 17, 2002;
revised manuscript received April 19, 2002,
accepted May 7, 2002.
* Reprint requests and correspondence: Dr. Paolo Voci, Via San Giovanni Eudes, 27 00163 Rome, Italy.
voci{at}uniroma1.it
OBJECTIVES: Patent perforators, noninvasively imaged by transthoracic color-Doppler echocardiography, may reflect adequate reperfusion in anterior myocardial infarction (MI).
BACKGROUND: The Thrombolysis In Myocardial Infarction (TIMI) classification may not fully reflect adequate myocardial reperfusion in MI.
METHODS: We studied 61 patients with anterior MI undergoing thrombolysis (n = 28), primary stenting (n = 20), or neither one (n = 13). High-resolution color-Doppler ultrasound was used to image the left anterior descending coronary artery (LAD) and perforators in four segments of the anterior-apical wall and to build a new recanalization score (RS). The TIMI flow was assessed by angiography. Wall motion score index (WMSI), ejection fraction (EF), end-diastolic volume index, and end-systolic volume index (ESVI) were measured by echocardiography at baseline and at three-month follow-up. Linear regression equations, considering RS or TIMI flow as independent variables, were compared among these functional recovery parameters. A multivariate linear model, predicting percent changes of WMSI, EF, or ESVI, was used to investigate the contribution of several clinical covariates along with RS and TIMI flow.
RESULTS: Sensitivity, specificity, and diagnostic accuracy of color-Doppler ultrasound in detecting LAD patency were 86%, 98%, and 97%, respectively. Mean and peak flow velocities discriminated (0.004 < p < 0.008) TIMI flow but not RS. Regression equations showed that RS discriminated better than TIMI flow recovery of ventricular function (p < 0.012). The RS was the best single multivariate predictor (p < 0.0001) of percent changes in WMSI, EF, and ESVI.
CONCLUSIONS: Transthoracic color-Doppler ultrasound detects an open LAD after MI. Perforators reflect adequate myocardial reperfusion and are early noninvasive markers of myocardial viability.
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Abbreviations and Acronyms
| | CK | | creatine kinase | | EDVI | | end-diastolic volume index | | EF | | ejection fraction | | ESVI | | end-systolic volume index | | LAD | | left anterior descending | | LV | | left ventricle/ventricular | | MB-CK | | myocardial creatine kinase fraction | | MI | | myocardial infarction | | RS | | recanalization score | | TIMI | | Thrombolysis In Myocardial Infarction | | WMSI | | wall motion score index |
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