Is acute myocardial infarction a localized or rather a global coronary phenomenon?

Abstract

Background: Use of qualitative assessment of coronary artery flow (TIMI), although widely spread, represents a subjective method, a quantitative assessment (CTFC) being necessary in order to standardize and facilitate comparisons and communications of angiographic trials. This study aims at appreciating whether myocardial infarction represents a global phenomenon that affects the whole myocardium, also affecting the coronary artery flow in non-culprit arteries.

Materials and methods: 66 patients that underwent primary PCI with stent and 66 patients with normal angiographic coronary arteries were studied. The number of frames necessary for the dye to reach certain standardized landmarks was registered, in order to objectively assess the coronary artery flow as a continuous variable. The statistical evaluations revealed that the quantitative assessment of the coronary flow through CTFC (corrected TIMI frame count) pins up a difference between the flow on non-culprit coronary arteries (23.54+/-9.235) and the flow on normal angiographic coronary arteries (17.46+/-4.1) (p<0.005), the result being also valid for each of the three coronary arteries separately analyzed: LAD (23.88+/-8.08 vs. 18.575+/-4.59 - p<0.005), CX (20.7+/-7.34 vs. 15.62+/-3.35 - p<0.005) and RCA (26.45+/-11.91 vs. 18.2+/-3.69 - p<0.005).

Conclusions: There are significant differences regarding the flow on non-culprit coronary arteries in patients that suffered acute myocardial infarction (AMI) and the flow on the coronary arteries of the patients with normal angiographic results; these data might be the expression of global myocardial suffering.