Measuring reperfusion in the catheter laboratory

Primary angioplasty has evolved as the reperfusion strategy of choice in acute ST-segment elevation myocardial infarction. Unlike thrombolytic therapy, it allows for direct visualization of the coronary anatomy and a targeted approach to revascularization. This is associated with significant improvements in culprit artery patency, distal myocardial perfusion, and, ultimately, patient prognosis. Assessment of reperfusion in this setting is heavily dependent upon the angiographic profile of the infarct-related artery after intervention. This incorporates both anatomical and physiological aspects of coronary function, with further delineation of epicardial and microvascular components of total coronary flow. More recent advances in contrast echocardiography and Doppler flow analysis have allowed for increasingly sophisticated and diverse measures of reperfusion that complement angiography and can all be used at the time of intervention in the catheter laboratory. Such information can guide immediate adjuvant therapy during angioplasty, in addition to identifying higher-risk groups of patients. Heart Metab. 2007;37:9–13.