Impact of spontaneous anterograde flow of the infarct artery on left ventricular function in patients with a first anterior wall acute myocardial infarction

To assess the impact of spontaneous anterograde flow of the infarct artery on outcomes in patients with acute myocardial infarction (AMI), we studied 478 patients with a first anterior wall AMI who underwent coronary angiography within 12 hours after the onset of chest pain; Thrombolysis In Myocardial Infarction (TIMI) 3 flow was obtained after reperfusion therapy. Patients were divided into 3 groups: 119 patients with spontaneous anterograde flow (initial TIMI 2 or 3 flow) of the infarct artery, 118 patients with an initially occluded artery (TIMI 0 or 1 flow) and time to angiography ≤2 hours (very early reperfusion), and 241 patients with an initially occluded artery and time to angiography of 2 to 12 hours (late reperfusion). Acute left ventricular (LV) ejection fraction (EF) was significantly higher in patients with spontaneous anterograde flow than in patients without (54 ± 14% vs 47 ± 10%, p <0.001). Predischarge LVEF was 65 ± 14% in patients with spontaneous anterograde flow, 55 ± 14% in patients with very early reperfusion, and 52 ± 14% in patients with late reperfusion (p <0.001). Similar trends were observed in the changes in LVEF (12 ± 14%, 8 ± 14%, and 4 ± 12%, p <0.001). Multivariate analysis showed that spontaneous anterograde flow was an independent predictor of preserved LV function, defined as a predischarge LVEF ≥55% (odds ratio 7.13, 95% confidence interval 3.10 to 16.4, p <0.001). In conclusion, although very early reperfusion improved LV function more than late reperfusion, spontaneous anterograde flow was associated with better acute and predischarge LV function after AMI compared with very early reperfusion of an initially occluded artery.