Is the determination of myocardial perfusion necessary to evaluate the success of reperfusion when the infarct-related artery is open?

W hen anterograde flow is restored to an occluded coronary artery in patients with acute myocardial infarction (AMI), it is generally presumed that flow is also restored to the myocardium. The article by Ito et all in this issue of Circulation reports that myocardial perfusion is absent in about one fourth of their population of patients with AMI despite reflow being achieved in the occluded vessel within 6 hours of onset of symptoms. In this study, myocardial contrast echocardiography (MCE) was used at the time of emergent cardiac catheterization to assess myocardial perfusion before and 15 minutes after successful reflow to the occluded coronary artery. This is the first published study demonstrating the no reflow phenomenon in patients with AMI using MCE.