Document Detail


Residual flow to the infarct zone against lethal ventricular tachyarrhythmias during the acute phase of myocardial infarction.
MedLine Citation:
PMID:  12918639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The benefits of residual flow to the infarct zone have been demonstrated in acute myocardial infarction (AMI), but its relation to ventricular tachyarrhythmias remains uncertain. HYPOTHESIS: This study was undertaken to test the hypothesis that residual flow is an important determinant of lethal ventricular tachyarrhythmias (sustained ventricular tachycardia or ventricular fibrillation) during the acute phase of AMI. METHODS: We investigated the determinants of lethal ventricular tachyarrhythmias within 24 h after the onset of symptoms in 310 consecutive patients (256 men; age 57.4 +/- 11.5 years) with AMI undergoing primary angioplasty. Patients were divided into two groups: those with (Group 1, n = 40) and those without (Group 2, n = 270) lethal ventricular tachyarrhythmias. Residual flow was defined as the presence of anterograde flow (> or = Thrombolysis in Myocardial Infarction [TIMI] 2 flow) or good angiographic collaterals (> or = grade 2) on a preintervention angiogram. RESULTS: Univariate determinants of lethal ventricular tachyarrhythmias were cardiogenic shock, systolic blood pressure, peak level of creatine kinase, culprit artery, spontaneous reperfusion, and residual flow. In multivariate analysis, however, cardiogenic shock (odds ratio [OR] = 4.79, 95% confidence interval [CI] 1.63-14.11, p = 0.004), residual flow (OR = 0.34, 95% CI 0.14-0.81, p = 0.015), and the right coronary artery as the culprit artery (OR = 2.09,95% CI 1.03-4.22, p = 0.040) were independent determinants of these arrhythmias. In-hospital death occurred in 10 patients and was more common in Group 1 than in Group 2 (12.5% vs. 1.9%, respectively, p < 0.001). CONCLUSION: The absence of residual flow was associated with greater risk of lethal ventricular tachyarrhythmias during the acute phase of AMI, suggesting a protective role of residual flow against these arrhythmias in AMI.
Authors:
Hyun Suk Yang; Cheol Whan Lee; Myeong-Ki Hong; Jae-Hwan Lee; Gi-Byoung Nam; Kee-Joon Choi; Jae-Joong Kim; Seong-Wook Park; You-Ho Kim; Seung-Jung Park
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  26     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-15     Completed Date:  2003-12-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-6     Citation Subset:  IM    
Affiliation:
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty
Coronary Angiography
Coronary Circulation / physiology*
Coronary Vessels / physiology*
Female
Humans
Male
Middle Aged
Myocardial Infarction / complications,  physiopathology*,  radiography
Pulsatile Flow
Regional Blood Flow
Tachycardia, Ventricular / complications,  physiopathology*,  radiography

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