Circulation. 2002;106:313-318
Published online before print June 24, 2002, doi: 10.1161/01.CIR.0000022691.71708.94
Published online before print June 24, 2002, doi: 10.1161/01.CIR.0000022691.71708.94
(Circulation. 2002;106:313.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Integrated Analysis of Myocardial Blush and ST-Segment Elevation Recovery After Successful Primary Angioplasty
Real-Time Grading of Microvascular Reperfusion and Prediction of Early and Late Recovery of Left Ventricular Function
Division of Cardiology, Ospedale Civile di Legnano, Legnano (MI), Italy.
Correspondence to Dr Arnaldo Poli, Division of Cardiology, Interventional Cardiology Laboratory, Ospedale Civile di Legnano, Legnano (MI), Italy. E-mail arnaldopoli{at}hotmail.com
Background— ST-segment elevation (
STe) recovery and the angiographic myocardial blush (MB) grade are useful markers of microvascular reperfusion after recanalization of the infarct-related artery. We investigated the ability of a combined analysis of MB grade and STe changes to identify different patterns of myocardial reperfusion shortly after primary percutaneous coronary angioplasty (PTCA) and to predict 7-day and 6-month left ventricular (LV) functional recovery.
Methods and Results— MB grade and STe recovery were evaluated shortly after successful primary PTCA (restoration of TIMI grade 3 flow) in 114 consecutive patients with STe acute myocardial infarction. LV function was assessed by 2D echocardiograms before PTCA and at 7 days and 6 months thereafter. By combining MB and STe changes, 3 main groups of patients were identified. Group 1 patients (n=60) had both significant MB (grade 2 to 3) and STe recovery (>50% versus basal STe) and a high rate of 7-day (65%) and 6-month (95%) LV functional recovery. In group 2 patients (n=21), who showed MB but persistent STe, the prevalence of early LV functional recovery was low (24%) but increased up to 86% in the late phase. Group 3 patients (n=28), who had neither significant MB nor STe resolution, had poor early (18%) and late (32%) LV functional recovery.
Conclusions— After successful primary PTCA, integrated analysis of MB and STe recovery allows a real-time grading of microvascular reperfusion of the infarct area and predicts the time-course and magnitude of LV functional recovery.
Key Words: myocardial infarction, acute • reperfusion • imaging
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