Published online before print April 14, 2003, doi: 10.1161/01.CIR.0000065221.06430.ED
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(Circulation. 2003;107:2115.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Angiographic Assessment of Reperfusion in Acute Myocardial Infarction by Myocardial Blush Grade
From Isala Klinieken, Hospital De Weezenlanden, Department of Cardiology, Zwolle, the Netherlands.
Correspondence to Dr F. Zijlstra, Isala Klinieken, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands. E-mail f.zijlstra{at}diagram-zwolle.nl
Background— Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that optimal angiographic reperfusion is defined by TIMI 3 flow and MBG 2 or 3.
Methods and Results— In 924 consecutive patients with TIMI 3 flow after angioplasty for acute myocardial infarction, we prospectively studied the value of MBG. End points were death, MACE, enzymatic infarct size, and residual left ventricular ejection fraction. Follow-up was 16±11 months. Of the 924 patients, 101 (11%) patients had MBG 0 or 1. Mortality was significantly higher in patients with MBG 0 or 1 compared with patients with MBG 2 or 3 (relative risk, 4.7; 95% CI, 2.3 to 9.5; P<0.001). The combined incidence of MACE was higher in patients with MBG 0 or 1 compared with patients with MBG 2 or 3 (relative risk, 1.8; 95% CI, 1.1 to 2.8; P=0.009). Enzymatic infarct size was larger (1437±2388 versus 809±1672, P=0.001) and left ventricular ejection fraction was lower (37.7±10.6 versus 43.8±11.1, P<0.001) in patients with MBG 0 or 1 compared with patients with MBG 2 or 3.
Conclusions— MBG is a strong angiographic predictor of mortality in patients with TIMI 3 flow after primary angioplasty. Enzymatic infarct size is larger and residual left ventricular ejection fraction is lower in patients with MBG 0 or 1 compared with MBG 2 or 3. Angiographic definition of successful reperfusion should include both TIMI 3 flow as well as MBG 2 or 3.
Key Words: angioplasty • myocardial infarction • reperfusion
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