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(Circulation. 2003;108:504.)
© 2003 American Heart Association, Inc.

Special Review: Clinician Update

Has My Patient Achieved Adequate Myocardial Reperfusion?

C. Michael Gibson, MS, MD

From the TIMI Study Group, Harvard Medical School.

Correspondence to C. Michael Gibson, MS, MD, Director TIMI Data Coordinating Center and Angiographic Core Laboratory, 350 Longwood Ave, First Floor, Boston MA 02115. E-mail mgibson@timi.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

For two decades, the goal of reperfusion has been restoration of normal epicardial blood flow.^1–4 It has, however, become increasingly apparent that not all TIMI grade 3 flow is created equally, and attention has shifted downstream to the restoration of normal myocardial perfusion to fully optimize clinical outcomes.^3,4 The goal of this Clinician Update is to provide clinicians with a better understanding of myocardial perfusion in terms of its importance, assessment, and treatment in clinical practice.

Case Presentation

A 59-year-old man presented to the emergency room with 2.5 hours of crushing substernal chest pain. The ECG showed 4 mm of ST-segment elevation in precordial leads V₁ through V₄, which was consistent with the diagnosis of acute anterior myocardial infarction. Primary angioplasty/stenting of a totally occluded left anterior descending artery was performed 90 minutes after presentation to the emergency room, resulting in restoration of normal Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow. The myocardium, however, appeared pale, which is consistent with TIMI myocardial perfusion grade (TMPG) 0 flow³ (Figure, A). Although improved, the patient’s ST segments remained elevated. Multiple doses of 100 µg of intracoronary adenosine were administered through the central lumen of the balloon catheter, resulting in restoration of TMPG 3 flow (Figure, B). After adenosine administration, the corrected TIMI frame count (CTFC)² improved from 50 frames to 35 frames. There was >70% resolution of ST-segment elevation, and the patient was free of chest pain.

View larger version (77K): [in this window] [in a new window]   A, Patent left anterior descending artery after stent placement. Note the . . . [Full Text of this Article]

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