TIMI Myocardial Perfusion Grade and Myocardial Viability Assessed by FDG-PET Scan after Primary PCI in Anterior AMI

초록

Purpose: The thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) is associated with the long term clinical outcomes in patients with acute myocardial infarction (AMI). This study was to compare the TMPG with the myocardial viability as determined by 18F-fluorodeoxyglucose positron emission tomography (FGD-PET) scan, and with improvement of the left ventricular (LV) function on echocardiography in anterior wall AMI. Methods: We enrolled 41 consecutive patients (34 men, age: 55±11 years) who underwent primary percutaneous coronary intervention (PCI) for anterior wall AMI. All infarct related arteries (IRA) were left anterior descending arteries, we excluded the left circumflex artery and the right coronary artery on coronary angiography. We assessed the coronary flow reserve (CFR), the diastolic deceleration time (DDT), the microvascular resistance index (MVRI) with intracoronary Doppler wire. All patients underwent FDG-PET scans on the 7th day after primary PCI. The patients were divided into 3 groups according to the TMPG (TMPG 0/1: n=18, TMPG 2: n=10, TMPG 3: n=13). Results: There was a significant correlation between the TMPG and the CFR, DDT, MVRI (r=0.349, p=0.032; r=0.606, p<0.001; r=-0.540, p=0.001, respectively). There was a significant correlation between the TMPG and the % of FDG uptake (r=0.531, p<0.001) and the patients with TMPG 3 had the most favorable the % of FDG uptake (TMPG 0/1 vs TMPG 2 vs TMPG 3; 42.4±13.1% vs 51.3±16.1% vs 58.3±12.4%, p=0.01). On echocardiography, the patients with TMPG 3 revealed a prominent improvement of the LV ejection fraction (54.3±10.3% vs 61.1±6.7%, p=0.009) and their regional wall motion abnormality (RWMA) index (1.34±0.29 vs 1.13±0.16, p=0.031). Conclusions: The TMPG determined by coronary angiography might be clinically useful for the assessment of myocardial viability and it might be a useful predictor for improvement of the LV function in patients with anterior wall AMI.