Echocardiographic predictors of remote outcome in patients with angiographically successful reflow after acute myocardial infarction

Background The angiographically no-reflow phenomenon after percutaneous coronary intervention (PCI) predicts poor left ventricular (LV) functional recovery and a high risk of cardiac events in patients with their first acute myocardial infarction (AMI). However, risk factors of long-term adverse outcome for patients with angiographically successful reflow (TIMI (Thrombolysis in Myocardial Infarction) flow grade 3) for the AMI remain unknown. Methods and Results Of 168 echocardiograms were performed before PCI and at discharge, 113 were suitable for analysis. Clinical, angiographic, and echocardiographic variables were submitted to statistical analysis to detect the risk factors of cardiac events. During the follow-up period of 46 20 months, 31 patients had cardiac events, though there were no cardiac deaths. The 2 most important risk factors for congestive heart failure (CHF) or total cardiac events were LV dilation (chi-square: 7.5 and 9.4; both p<0.01) and pseudonormal transmittal flow pattern (PN, chi-square: 4.9, p<0.05 and 6.7, p<0.01, respectively). However, only multivessel disease (chi-square: 9.4, p=0.05) became the predictor for revascularization after PCI. The incidence of CHF or total cardiac events in patients with PN and LV dilation at discharge determined by the Kaplan-Meier method were significantly higher than those with normal or abnormal relaxation transmitral flow pattern (log-rank: 41 and 27, both p<0.001) and no LV dilation (log-rank: 20 and 20, both p<0.001). Conclusion Poor LV diastolic function and LV dilation at discharge are predictors of the cardiac events in patients in whom epicardial coronary flow was well-restored after PCI for the first AMI.