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The significance of dynamic changes of coronary blood flow during primary angioplasty in patients with acute myocardial infarction.

Jarosław Zalewski, Krzysztof Żmudka, Wojciech Zajdel, Marek Tomala, Jarosław Trębacz, Tadeusz Przewłocki*, Grzegorz Gajos**, Dariusz Dudek***, Piotr Pieniążek*
Instytut Kardiologii, ZhiA; * Instytut Kardiologii, Klinika Chorób Serca i Naczyń; ** Instytut Kardiologii, Klinika Choroby Wieńcowej; *** Instytut Kardiologii, II Klinika Kardiologii; Kraków


The purpose of the study was to estimate the relation between dynamic changes of coronary blood flow during reperfusion and selected clinical, hemodynamic and ECG parametres in patients undergoing primary angioplasty.

Material: 149 patients with AMI, mean age 54.7 ± 10.5 years treated with primary angioplasty were included. There were 55 pts with anterior, 20 pts with lateral and 74 pts with inferior AMI.

Methods: Selected clinical, ECG (total ST elevation [tST]) and hemodynamic data (systolic pressure[SP]/heart rate[HR]) were collected before [0], immediately after [1] and 24h after [24] intervention. Coronary flow graded by TIMI and TIMI frame count [TFC] were assessed before [I], immediately after recanalisation of infarct related artery (IRA) [II] and after the procedure [III]. Difference between TFCIII and TFCII was defined as flow delay [DTFC].

Results: The success rate of IRA recanalisation was 94.6%. Early mortality was 6.7% (70% pts who died had final TIMI-0-2). Majority of pts (89.3%) with successful recanalisation achieved TIMI-3 flow. Chest pain duration for pts with TIMI-3 was 3.2 ± 2.1h and for TIMI-0-2 was 4.3 ± 2.4h (p<0.05). DTFC was significantly lower in pts with history of previous angina (2.9 ± 10.2 vs. 6.6 ± 12.4, p<0.05) and with collateral flow to IRA (1.2 ± 3.2 vs. 6.4 ± 15.7, p<0.05). DTFC was not influenced by stent implantation (3.8 ± 12.1 vs. 4.8 ± 13.9, ns). DTFC correlates with ST-segment regression expressed as [tST1/tST0] (r=0.78, p<0,0001) and with hemodynamic status expressed as [SP24/HR24] (r=-0.5, p<0.05).

Conclusions: DTFC may be a useful predictor of the extent of myocardial injury during reperfusion in patients with AMI treated by primary angioplasty.








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