Abstract 1678: Angiographic Perfusion Score in Patients Treated with PCI at Late Angiography Following Fibrinolytic Administration for ST-Segment Elevation Myocardial Infarction is Associated with Morbidity and Mortality at 30 days
Background: Among STEMI patients, evidence of restoration of both normal epicardial arterial flow and myocardial perfusion early after the administration of fibrinolytic agents has been associated with improved clinical outcomes. In STEMI patients treated with fibrinolytic therapy and scheduled for angiography later during hospital admission, however, the association of indices of flow and perfusion with clinical outcomes has not been assessed.
Methods: CLARITY-TIMI 28 enrolled 3,491 STEMI patients treated with fibrinolytic therapy. Angiography was scheduled 48–192 hours (median 84) after randomization. The Angiographic Perfusion Score (APS), which is defined as the sum of the TIMI Flow Grade and Myocardial Perfusion Grade before and after PCI (range of 0–12), was assessed in the 1,460 patients treated with PCI at late angiography, and its association with morbidity and mortality at 30 days was examined.
Results: Full perfusion, defined as an APS of 10–12, was associated with the lowest mortality (0.8%), while partial perfusion (APS 4–9) (2.3%) and failed perfusion (APS 0–3) (18.0%) were associated with a higher incidence of mortality at 30 days (p<0.001 for full perfusion vs. partial perfusion, p<0.0001 for overall trend) (Figure⇓). In addition, full perfusion was associated with a lower incidence of recurrent MI, a composite of death and MI, recurrent myocardial ischemia, ventricular tachyarrhythmia, CHF and shock (p<0.05 for all trends).
Conclusion: Among STEMI patients treated with late PCI following fibrinolytic therapy, higher APS is associated with reduced morbidity and mortality.