Pressure derived coronary collateral flow during rescue PCI was higher in patients with TMP 0 versus TMP 1-3 (0.30 vs 0.15, p<0.0001) but did not predict left ventricular function recovery.
Cohort (n=38)
Does pressure derived coronary collateral flow predict improvement in left ventricular function in patients undergoing rescue PCI for failed reperfusion in acute myocardial infarction?
Increased pressure-derived coronary collateral flow in acute myocardial infarction reflects a dysfunctional microcirculation rather than collateral protection, and does not predict LV function recovery after rescue PCI.
OBJECTIVE: To evaluate the relation between pressure derived coronary collateral flow (PDCF) index and angiographic TIMI (thrombolysis in myocardial infarction) myocardial perfusion (TMP) grade, angiographic collateral grade, and subsequent recovery of left ventricular function after rescue percutaneous coronary intervention (PCI) for failed reperfusion in acute myocardial infarction. METHODS: The pressure wire was used as the guidewire in 38 consecutive patients who underwent rescue PCI between December 2000 and March 2002. Follow up angiography was performed at six months. Baseline and follow up single plane ventriculograms were analysed off line by an automated edge detection technique. A linear model was fitted to assess the relation between 0.1 unit increase in PDCF and change in left ventricular regional wall motion. RESULTS: Patients with TMP 0 grade had significantly higher mean (SD) PDCF than patients with TMP 1-3 (0.30 (0.11) v 0.15 (0.07), p 20 mm Hg v 0.22 (0.09) with end diastolic pressure < 20 mm Hg, p = 0.08, r = 0.2). No correlation was observed between PDCF and Rentrops collateral grade (0.26 (0.13) with grade 0 v 0.25 (0.11) with grades 1-3, p = 0.4, r = -0.06). No linear relation existed between changes in PDCF and changes in left ventricular regional wall motion. CONCLUSION: PDCF in the setting of rescue PCI for failed reperfusion after thrombolysis does not predict improvement in left ventricular function. Increased PDCF and coronary wedge pressure in acute myocardial infarction reflect a dysfunctional microcirculation rather than good collateral protection.
Kanarath Balachandran (Tue,) conducted a cohort in Acute myocardial infarction with failed reperfusion (n=38). Pressure derived coronary collateral flow (PDCF) measurement was evaluated on Change in left ventricular regional wall motion. Pressure derived coronary collateral flow during rescue PCI was higher in patients with TMP 0 versus TMP 1-3 (0.30 vs 0.15, p<0.0001) but did not predict left ventricular function recovery.