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Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction

      Abstract

      Spontaneous recanalization (SR) occurs after the onset of acute myocardial infarction (AMI), but its clinical significance in the reperfusion era remains uncertain. We evaluated the determinants and prognostic significance of SR in 196 consecutive patients with AMI who underwent primary angioplasty at our institution. The study population was divided into 2 groups according to the presence (group I, n = 44) or absence (group II, n = 152) of SR (Thrombolysis In Myocardial Infarction [TIMI] anterograde ≥2 flow on the preintervention angiogram). The primary end point was the occurrence, within 6-weeks after AMI, of death, nonfatal reinfarction, and congestive heart failure. Baseline characteristics were similar between the 2 groups. Peak levels of creatine kinase were lower in group I than in group II (2,500 ± 1,800 vs 4,000 ± 2,900 U/L, respectively, p <0.05). The rate of TIMI flow grade 3 after intervention was higher in group I than in group II (93.2% vs 79.6%, respectively, p <0.05), and patients in group I had a faster corrected TIMI frame count than those in group II (22.7 ± 12.4 vs 30.3 ± 22.8, respectively, p <0.05). Preinfarction angina (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.10 to 4.33, p <0.05), heavy thrombi (OR 0.10, 95% CI 0.01 to 0.74, p <0.05), and good angiographic collaterals (OR 0.12, 95% CI 0.02 to 0.89, p <0.05) were independent predictors of SR. Death, reinfarction, and severe arrhythmia were not different between the 2 groups. However, heart failure occurred more frequently in group II than in group I (15.1% vs 2.3%, respectively, p <0.05). The primary end point was also significantly lower in group I than in group II (4.5% vs 18.4%, respectively, p <0.05). In conclusion, SR in AMI is associated with faster coronary flow, smaller infarct size, and a better clinical outcome after primary angioplasty.
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      References

        • Lincoff A.M.
        • Topol E.J.
        Illusion of reperfusion.
        Circulation. 1993; 88: 1361-1374
        • Gibson C.M.
        Primary angioplasty compared with thrombolysis.
        Ann Intern Med. 1999; 130: 841-847
        • Zijstra F.
        • Hoorntje J.C.A.
        • de Boer M.J.
        • Reiffers S.
        • Miedema K.
        • Ottervanger J.P.
        • van‘t Hof A.W.J.
        • Suryapranata H.
        Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction.
        N Engl J Med. 1999; 341: 1413-1419
        • Grines C.L.
        • Cox D.A.
        • Stone G.W.
        • Garcia E.
        • Mattos L.A.
        • Giambartolomei A.
        • Brodie B.R.
        • Madonna O.
        • Eijgelshoven M.
        • Lansky A.J.
        • O’Neill W.W.
        • Morice M.C.
        Coronary angioplasty with or without stent implantation for acute myocardial infarction.
        N Engl J Med. 1999; 341: 1949-1956
        • Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators
        A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction.
        N Engl J Med. 1997; 336: 1621-1628
        • Maseri A.
        • L’Abbate A.
        • Baroldi G.
        • Chierchia S.
        • Marzilli M.
        • Ballestra A.M.
        • Severi S.
        • Parodi O.
        • Biagini A.
        • Distante A.
        • Pesola A.
        Coronary vasospasm as a possible cause of myocardial infarction.
        N Engl J Med. 1978; 299: 1271-1277
        • Folts J.D.
        • Crowell Jr, E.B.
        • Rowe G.G.
        Platelet aggregation in partially obstructed vessels and its elimination with aspirin.
        Circulation. 1976; 54: 365-370
        • Anzai T.
        • Yoshikawa T.
        • Asakura Y.
        • Abe S.
        • Akaishi M.
        • Mitamura H.
        • Ogawa S.
        • Handa S.
        Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction.
        J Am Coll Cardiol. 1995; 26: 319-327
        • Kloner R.A.
        • Shook T.
        • Pryzlenk K.
        • Davis V.G.
        • Junio L.
        • Matthews R.V.
        • Burstein S.
        • Gibon M.
        • Poole W.K.
        • Cannon C.P.
        • McCabe C.H.
        • Brunwald E.
        • TIMI 4 investigators
        Previous angina alters in-hospital outcome in TIMI 4.
        Circulation. 1995; 91: 37-47
        • Kloner R.A.
        • Shook T.
        • Antman E.M.
        • Cannon C.P.
        • Przyklenk K.
        • Yoo K.
        • McCabe C.H.
        • Braunwald E.
        • TIMI-9B Investigators
        Prospective temporal analysis of the onset of preinfarction angina versus outcome.
        Circulation. 1998; 97: 1042-1045
        • Andeotti F.
        • Pasceri V.
        • Hackett D.R.
        • Davies G.J.
        • Haider A.W.
        • Maseri A.
        Preinfarction angina as a predictor of more rapid coronary thrombolysis in patients with acute myocardial infarction.
        N Engl J Med. 1996; 334: 7-12
        • Bahr R.
        • Leino E.V.
        • Christenson R.H.
        Prodromal unstable angina in acute myocardial infarction.
        Am Heart J. 2000; 140: 126-133
        • Muller D.W.
        • Topol E.J.
        • Califf R.M.
        • Sigmon K.N.
        • Gorman L.
        • George B.S.
        • Kereiakes D.J.
        • Lee K.L.
        • Ellis S.G.
        Relationship between antecedent angina pectoris and short-term prognosis after thrombolytic therapy for acute myocardial infarction.
        Am Heart J. 1990; 119: 224-231
        • Hata K.
        • Whittaker P.
        • Kloner R.A.
        • Przyklenk K.
        Brief antecedent ischemia attenuates platelet-mediated thrombosis in damaged and stenotic canine coronary arteries.
        Circulation. 1998; 97: 692-702
        • Przyklenk K.
        • Whittaker P.
        Brief antecedent ischemia enhances recombinant tissue plasminogen activator-induced coronary thrombolysis by adenosine-mediated mechanism.
        Circulation. 2000; 102: 88-95
        • TIMI study group
        The Thrombolysis In Myocardial Infarction (TIMI) trial:phase I findings.
        N Engl J Med. 1985; 312: 932-936
        • Gibson C.M.
        • Cannon C.P.
        • Daley W.L.
        • Dodge J.T.
        • Alexander B.
        • Marble S.J.
        • McCabe C.H.
        • Raymond L.
        • Fortin T.
        • Poole K.
        • Braunwald E.
        • TIMI 4 Study Group
        TIMI frame count. A quantitative method of assessing coronary artery flow.
        Circulation. 1996; 93: 879-888
        • Rentrop K.P.
        • Feit F.
        • Sherman W.
        • Thornton J.C.
        Serial angiographic assessment of coronary artery obstruction and collateral flow in acute myocardial infarction.
        Circulation. 1989; 80: 1166-1175
        • Pijls N.H.J.
        • Bech J.W.
        • El Gamal H.I.H.
        • Bonnier H.J.R.M.
        • De Bruyne B.
        • Van Gelder B.
        • Michels H.R.
        • Koolen J.J.
        Quantification of recruitable coronary collateral blood flow in conscious human and its potential to predict future ischemic events.
        J Am Coll Cardiol. 1995; 25: 1522-1528
        • Gensini G.G.
        • daCosta B.C.B.
        The coronary collateral circulation in living man.
        Am J Cardiol. 1969; 24: 393-400
        • Gibson C.M.
        • Murphy S.A.
        • Rizzo M.J.
        • Ryan K.A.
        • Marble S.J.
        • McCabe C.H.
        • Cannon C.P.
        • de Werf F.V.
        • Braunwald E.
        Relationship between TIMI frame count and clinical outcomes after thrombolytic administration.
        Circulation. 1999; 99: 1945-1950
        • Feliciano L.
        • Henning R.J.
        Coronary artery blood flow.
        Clin Cardiol. 1999; 22: 775-786
        • Agati L.
        Microvascular integrity after reperfusion therapy.
        Am Heart J. 1999; 138: S76-S78
        • Gibson C.M.
        • Murphy S.
        • Menown I.B.A.
        • Sequeira R.F.
        • Greene R.
        • de Werf F.V.
        • Schweiger M.J.
        • Ghali M.
        • Frey M.J.
        • Ryan K.A.
        • Marble S.J.
        • Giugliano R.P.
        • Antman E.M.
        • Cannon C.P.
        • Braunwald E.
        • TIMI Study Group
        Determinants of coronary blood flow after thrombolytic administration.
        J Am Coll Cardiol. 1999; 34: 1403-1412
        • Ross A.M.
        • Coyne K.S.
        • Reiner J.S.
        • Greenhouse S.W.
        • Fink C.
        • Frey A.
        • Moreyra E.
        • Traboulsi M.
        • Racine N.
        • Riba A.L.
        • Thompson M.A.
        • Rohrbeck S.
        • Lundergan C.F.
        • PACT Investigators
        A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction.
        J Am Coll Cardiol. 1999; 34: 1954-1962
        • Grech E.D.
        • Sutton A.G.
        • Campbell P.G.
        • Ashton V.J.
        • Price D.J.A.
        • Hall J.A.
        • de Belder M.A.
        Reappraising the role of immediate intervention following thrombolytic recanalization in acute myocardial infarction.
        Am J Cardiol. 2000; 86: 400-405