Comparison of clinical outcomes between sufficient versus insufficient diagonal branch flow in anterior acute myocardial infarction

  • Kei Yamamoto
  • Kenichi SakakuraEmail author
  • Naoyuki Akashi
  • Yusuke Watanabe
  • Masamitsu Noguchi
  • Yousuke Taniguchi
  • Hiroshi Wada
  • Shin-ichi Momomura
  • Hideo Fujita
Original Article


In primary percutaneous coronary intervention (PCI), revascularization to the main branch is considered to be more important than that to the side branch. The purpose of the present study was to compare in-hospital clinical outcomes between sufficient and insufficient diagonal flow in patients with anterior ST-elevation acute myocardial infarction. A total of 229 left anterior descending artery (LAD)-AMI with final Thrombolysis in Myocardial Infarction (TIMI)-3 LAD flow were included, and divided into the sufficient diagonal flow group (TIMI-3 diagonal flow: n = 170) and the insufficient diagonal flow group (TIMI ≤ 2 diagonal flow: n = 59). The primary endpoint was the incidence of mechanical complication. The secondary endpoints were incidences of in-hospital death, heart failure at discharge, and left ventricular thrombus. There were no significant differences in the primary endpoint (the sufficient diagonal flow group: 1.2%, the insufficient diagonal flow group: 0%, P = 0.403). In-hospital death was more frequently observed in the insufficient diagonal flow group (8.5%) than the sufficient diagonal flow group (2.9%) without reaching statistical significance (P = 0.073). The incidence of heart failure at discharge, and thrombus in left ventricular were not different between the two groups. In conclusion, in-hospital outcomes were not significantly different between the sufficient and insufficient diagonal flow groups. We may not stick to the diagonal flow in LAD-STEMI, as long as the LAD flow is maintained by PCI.


Acute myocardial infarction Left anterior descending artery Diagonal branch Percutaneous coronary intervention 



The authors acknowledge all staff in the catheter laboratory in Saitama Medical Center, Jichi Medical University for their technical support in this study.



Compliance with ethical standards

Conflict of interest

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, and NIPRO; has served as a proctor for Rotablator for Boston Scientific; and has served as a consultant for Abbott Vascular and Boston Scientific. Prof. Fujita served as a consultant for Mehergen Group Holdings, Inc. Other authors declare no conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiovascular Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan

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