Early prediction of myocardial salvage after primary coronary angioplasty: comparative study of coronary flow velocity pattern immediately after primary coronary angioplasty and perfusion-metabolism mismatch.

OBJECTIVES Perfusion-metabolism mismatch in the subacute phase using thallium-201/radio iodinated beta-methyl-p-iodophenyl pentadecanoic acid (T1/BMIPP) dual scintigraphy is an indicator of viable myocardium in acute myocardial infarction. This study investigated early prediction of myocardial salvage from the T1/BMIPP mismatch and coronary flow velocity (CFV) patterns in patients with acute myocardial infarction. METHODS Thirty three patients with first anterior wall myocardial infarction underwent primary coronary angioplasty and achieved reflow within 8 hr of onset. By using a Doppler guide wire, CFV patterns were assessed immediately after primary coronary angioplasty. T1/BMIPP dual scintigraphy was performed within 3 days after reperfusion. The extent of discordance in severity score was defined as the T1/BMIPP mismatch score. RESULTS Regression analysis showed dual scintigraphy mismatch score correlated well with deceleration time of diastolic flow velocity (r = 0.54, p < 0.01). Mismatch score was greater in the non-early systolic reversal flow group than in the early systolic reversal flow group (5.5 +/- 3.3 vs 1.9 +/- 2.1, respectively, p < 0.01). CONCLUSIONS Changes in CFV patterns correlated well with T1/BMIPP mismatch score. CFV pattern immediately after reperfusion is useful for early prediction of myocardial salvage.