Intravenous versus intracoronary myocardial contrast echocardiography for evaluation of no-reflow after primary percutaneous coronary intervention

OBJECTIVE: We sought to compare intravenous myocardial contrast echocardiography (IV-MCE) with intracoronary myocardial contrast echocardiography (IC-MCE) in detecting no-reflow and predicting the short-term outcome of left ventricular function after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). METHODS: IC-MCE and IV-MCE were performed immediately after PCI (D1) of 28 patients with anterior wall AMI. IV-MCE was repeated at the next day of PCI (D2), and left ventricular systolic function was evaluated at D2 and 30 days later (D30). RESULTS: There was good agreement between IC-MCE and IV-MCE at D1 in determining no-reflow (kappa= 0.78, P < 0.001) as well as between IV-MCE at D1 and D2 (kappa= 0.93, P < 0.001). The patients with no-reflow on IC-MCE (n = 13) and those on IV-MCE at D2 (n = 11) showed no improvement in left ventricular ejection fraction (LVEF) after 1 month (49 +/- 9% to 48 +/- 7%, P = 0.55, and 51 +/- 6% to 49 +/- 7%, P = 0.20). However, the patients with reflow on IC-MCE (n = 15) and those on IV-MCE at D2 (n = 17) demonstrated significant improvement in LVEF (55 +/- 6% to 62 +/- 5%, P < 0.005, and 53 +/- 7% to 60 +/- 8%, P < 0.005). In predicting segmental functional recovery after 1 month, sensitivity and specificity of IC-MCE were 85% and 67%, respectively, and those of IV-MCE at D2 were 95% and 40%, respectively. CONCLUSION: IV-MCE at D2 might be substituted for IC-MCE performed immediately after PCI for the evaluation of no-reflow and prediction of left ventricular systolic function after 1 month in patients with anterior wall AMI.