752-5 Dose the “No Reflow” Phenomenon Immediately After Successful Direct Angioplasty Always Indicate Poor Functional Recovery?

Experimental studies have demonstrated that “no reflow” phenomenon after prolonged coronary occlusion indicates advanced myocardial necrosis. In clinical settings, previous studies have suggested that presence of “no reflow” phenomenon following thrombolysis is a useful predictor of poor functional recovery. To test the hypothesis that “no reflow” phenomenon is closely related to the recovery of regional wall motion in a reperfused AMI, we studied 42 myocardial segments in 18 patients with AMI who achieved successful direct angioplasty. MCE was performed immediately after direct angioplasty and repeated 2 weeks later with intracoronary injection of sonicated albumin. Contrast effect in each segment was scored as 0–2 (0, 1 and 2 denoting no, partial and homogeneous contrast effect, respectively). 2D-Echo was performed at day-1 and repeated 1 month later. Wall motion (WM) by 2D-Echo was scored as 0–3 (scores of 0 to 3 indicating dys/akinetic segments to normal. respectively). The relation between mean WM and MCE score immediately after direct angioplasty was as follows: MCE score day-l WM 1 Month WM Change 2 (n = 20) 1.1 ± 0.8 ** 1.7 ± 0.7 * , # 0.6 ± 0.9 1 (n = 7) 0.6 ± 0.8 * 1.4 ± 1.4 # 0.9 ± 0.9 0 (n = 15) 0.0 ± 0.0 0.8 ± 1.0 ## 0.8 ± 1.0 * p l 0.01 ** p l 0.001 vs. MCE score = 0 # p l 0.05 ## p l 0.01 vs. day-l WM Seven of 15 segments (47%) with MCE score = 0 immediately after direct angioplasty showed functional recovery at 1 month later, and 6 of the 7 segments (86%) showed contrast enhancement at 2 weeks later restudy. Conclusion About one half of segments which showed no contrast enhancement immediately after direct angioplasty showed functional recovery at 1 month later, and the majority of these segments showed contrast enhancement at 2 weeks later restudy. The “no reflow” phenomenon by MCE immediately after successful direct angioplasty dose not always indicate poor functional recovery.