Background: Primnary percutaneous coronary intervention (PPCI) is the treatment of choice in acute ST elevation myocardial infraction (STEMI). Early PPCI is important to resume coronary flow and improve myocardial perfusion .Unfortunately PPCI outcome may be suboptimal.
Aim: Evaluation of the effects of Intra aortic balloon (IABP) on coronary flow, myocardial perfusion and left ventricular systolic function in patients with acute anterior STEMI and suboptimal PPCI outcome.
Methods: Fifty five patients with acute anterior STEMI had suboptimal PPCI outcome according to TIMI grade and myocardial blush grades (MBG). 27 were treated by IABP and 28 served as a control group. TIMI and MBG grade were evaluated before and after PPCI. Flow in the LAD was evaluated using Trans thoracic Doppler (TTE) with and without pumping. Left ventricular systolic function was valuated by TTE, early after PPCI and at discharge. LVEF, LAD wall motion score index (LAD-WMSI) and LV WMSI (LV-WMSI) were measured.
Results: IABP doubled diastolic LAD flow. LVEF at admission was lower in the IABP group compared to controls but both were similar at discharge. IABP increased LVEF by more than 5 % in 70% of patients treated with IABP. Patients who increased their LVEF were younger, and had lower prevalence of smoking 32% vs. 80%, obesity 11% vs. 40%, renal failure 0 % vs. 40%, KILLIP class 1.75 vs. 2.7 and had lower prevalence of previous PCIs. TIMI and MBG grades after PPCI were higher in these patients, and higher prevalence of single LAD disease. LAD systolic velocities and time velocity integrals and pressure half time while the IABP is off were larger in those who increased LVEF. During pumping, diastolic velocity and integrals were higher with improved LVEF. Conclusions: In anterior STEMI and suboptimal PPCI, TTE Doppler can monitor LAD flow and allow adjustments. LV systolic function improved in 70% in the IABP-group despite lower admission-LVEF. Clinical, angiographic and LAD Doppler velocity parameters may help predict improvement.
