P355Acute coronary syndrome is a global myocardial phenomenon

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Abstract

Premises

The use of qualitative evaluation of coronary flow (TIMI) is a subjective assay and a quantitative evaluation is necessary in order to standardize and to facilitate the comparisons and the communication of angiographic results. The goals of this study are: to establish normal values for the quantitative analysis of the coronary flow in a control group; the evaluation of the coronary flow on arteries that are not involved in Acute Coronary Syndromes (ACS) in order to establish if this is a phenomenon that affects the whole myocardium, or a local one that affects a limited area of the myocardium.

Material and methods

Between April 2006 and April 2009 110 patients that underwent PTCA with stent for ACS were included in the study, as well as 230 patients with valvular heart disease and normal coronary angiography that were subjected to coronary angiography for the surgical protocol. In order to eliminate any errors patients with aortic stenosis and/or angina were excluded from the control group. The number of frames necessary for the contrast to reach certain distal standard landmarks was recorded, thus analyzing coronary flow as a continuous variable. The diameter of the vessel was then taken into account, all bias in comparing coronary flow being thus eliminated. Statistical tests have proven that quantitative evaluation of coronary flow through corrected TIMI frame count (CTFC) correlated with vessel diameter (TIMI/MLD) detects a difference between coronary flow in non-culprit arteries in ACS patients (8,182 ± 2,1112) and flow in normal angiographic coronary arteries (5,441 ± 0,9950) (p < 0,005), the result being valid for each of the three coronary arteries separately analyzed: LAD (8,121 ± 2,2121 vs. 5,247 ± 1,0327 — p < 0,005), Cx (7,972 ± 1,951 vs. 5,584 ± 0,9214 — p < 0,005), and RCA (8,244 ± 2,1248 vs. 5,341 ± 0,9752 — p < 0,005).

Conclusion

A significant group of patients with normal angiographic coronary arteries has been evaluated, and the establishment of normal values for quantitatively evaluated coronary flow in the control group has been achieved. Significant differences between the flow in non-culprit coronary arteries in ACS patients and the flow in normal angiographic coronary arteries patients has been detected, thus showing the possibility that these data are the expression of global myocardial suffering in ACS.

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