Study objective: To assess the effect of coronary flow
to the infarct zone before primary coronary angioplasty on hospital
complications in patients with acute myocardial infarction (MI).
Design: Consecutive case series analysis.
Setting: Coronary-care unit in a university hospital.
Patients: Two hundred sixty-four consecutive patients with
ST-elevation acute MIs who had successful primary percutaneous
transluminal coronary angioplasty.
Coronary angiography on hospital admission and serial
Measurements and results: The status
of infarct-related artery flow before primary angioplasty was evaluated
on hospital admission. Left ventricular wall motion and pericardial
effusions were studied by echocardiography. One hundred ninety patients
had total occlusions (Thrombolysis in Myocardial Infarction [TIMI]
flow grade, 0 to 1) in the infarct-related artery (group 1), and 74
patients had antegrade flow (TIMI flow grade, 2 to 3) [group 2]
before undergoing primary angioplasty procedures. When group 1 was
subdivided into two groups (for the presence and absence of collateral
flow), the patients with total occlusions and no collateral flow had a
higher incidence of left ventricular aneurysmal wall motion (11% vs
1%, respectively; p = 0.03) and pericardial friction rub (15% vs
3%, respectively; p = 0.03) than did those in group 2. Moreover,
those patients with total occlusions and no collateral flow had higher
incidences of pericardial effusion (34% vs 17%, respectively;
p = 0.02; and 34% vs 9%, respectively; p < 0.01) and in-hospital
mortality (8% vs 1%, respectively; p = 0.04; and 8% vs 1%,
respectively; p = 0.06) than did those patients in the other two
Conclusions: Despite successful primary
angioplasty, the absence of antegrade flow in the infarct-related
artery and collateral flow to the infarct zone before angioplasty
resulted in a higher incidence of in-hospital