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
This article has been cited by other articles:
 |
|
 |
|
  P. J. Vlaar, T. Svilaas, M. Vogelzang, G. F. Diercks, B. J. de Smet, A. F. van den Heuvel, R. L. Anthonio, G. A. Jessurun, E. Tan, A. J. Suurmeijer, et al. A Comparison of 2 Thrombus Aspiration Devices With Histopathological Analysis of Retrieved Material in Patients Presenting With ST-Segment Elevation Myocardial Infarction J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 258 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Brener, D. J. Moliterno, P. E. Aylward, A. W.J. van't Hof, W. Ruzyllo, W. W. O'Neill, C. W. Hamm, C. M. Westerhout, C. B. Granger, P. W. Armstrong, et al. Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI Angiographic Study Eur. Heart J., May 1, 2008; 29(9): 1127 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. O. Spiel, J. C. Gilbert, and B. Jilma Von Willebrand Factor in Cardiovascular Disease: Focus on Acute Coronary Syndromes Circulation, March 18, 2008; 117(11): 1449 - 1459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Direct Inhibition of {delta}-Protein Kinase C Enzy Intracoronary KAI-9803 as an Adjunct to Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction Circulation, February 19, 2008; 117(7): 886 - 896. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Svilaas, P. J. Vlaar, I. C. van der Horst, G. F.H. Diercks, B. J.G.L. de Smet, A. F.M. van den Heuvel, R. L. Anthonio, G. A. Jessurun, E.-S. Tan, A. J.H. Suurmeijer, et al. Thrombus Aspiration during Primary Percutaneous Coronary Intervention N. Engl. J. Med., February 7, 2008; 358(6): 557 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Vetrovec Improving Reperfusion in Patients with Myocardial Infarction N. Engl. J. Med., February 7, 2008; 358(6): 634 - 637. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Galiuto, B. Garramone, A. Scara, A. G. Rebuzzi, F. Crea, G. La Torre, S. Funaro, M. Madonna, F. Fedele, L. Agati, et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling: results of the multicenter AMICI study. J. Am. Coll. Cardiol., February 5, 2008; 51(5): 552 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Terkelsen and H. R. Andersen Value of ST-resolution analysis in the era of primary percutaneous coronary intervention Heart, January 1, 2008; 94(1): 13 - 15. [Full Text] [PDF]
|
|
|
|
|
|
M. Maioli, F. Bellandi, M. Leoncini, A. Toso, and R. P. Dabizzi Randomized Early Versus Late Abciximab in Acute Myocardial Infarction Treated With Primary Coronary Intervention (RELAx-AMI Trial) J. Am. Coll. Cardiol., April 10, 2007; 49(14): 1517 - 1524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mariani, R. Fetiveau, E. Rossetti, A. Poli, F. Poletti, P. Vandoni, M. D'Urbano, F. Cafiero, G. Mariani, C. Klersy, et al. Significance of total and differential leucocyte count in patients with acute myocardial infarction treated with primary coronary angioplasty Eur. Heart J., November 1, 2006; 27(21): 2511 - 2515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Suzuki, T. Sakaue, M. Tanaka, E. Hirose, H. Saeki, T. Matsunaka, S. Hiramatsu, and Y. Kazatani Association Between Right Bundle Branch Block and Impaired Myocardial Tissue-Level Reperfusion in Patients With Acute Myocardial Infarction J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2122 - 2124. [Full Text] [PDF]
|
|
|
|
|
|
A Prasad and B J Gersh Management of microvascular dysfunction and reperfusion injury Heart, December 1, 2005; 91(12): 1530 - 1532. [Full Text] [PDF]
|
|
|
|
|
|
P. Staat, G. Rioufol, C. Piot, Y. Cottin, T. T. Cung, I. L'Huillier, J.-F. Aupetit, E. Bonnefoy, G. Finet, X. Andre-Fouet, et al. Postconditioning the Human Heart Circulation, October 4, 2005; 112(14): 2143 - 2148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Chareonthaitawee, B. J. Gersh, P. A. Araoz, and R. J. Gibbons Revascularization in Severe Left Ventricular Dysfunction: The Role of Viability Testing J. Am. Coll. Cardiol., August 16, 2005; 46(4): 567 - 574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H S Gurm and E J Topol The ECG in acute coronary syndromes: new tricks from an old dog Heart, July 1, 2005; 91(7): 851 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sorajja, B. J. Gersh, C. Costantini, M. G. McLaughlin, P. Zimetbaum, D. A. Cox, E. Garcia, J. E. Tcheng, R. Mehran, A. J. Lansky, et al. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction Eur. Heart J., April 1, 2005; 26(7): 667 - 674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. Stone, J. Webb, D. A. Cox, B. R. Brodie, M. Qureshi, A. Kalynych, M. Turco, H. P. Schultheiss, D. Dulas, B. D. Rutherford, et al. Distal Microcirculatory Protection During Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Trial JAMA, March 2, 2005; 293(9): 1063 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Prasad, G. W. Stone, T. D. Stuckey, C. O. Costantini, P. J. Zimetbaum, M. McLaughlin, R. Mehran, E. Garcia, J. E. Tcheng, D. A. Cox, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction J. Am. Coll. Cardiol., February 15, 2005; 45(4): 508 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. McLaughlin, G. W. Stone, E. Aymong, G. Gardner, R. Mehran, A. J. Lansky, C. L. Grines, J. E. Tcheng, D. A. Cox, T. Stuckey, et al. Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: The controlled abciximab and device investigation to lower late angioplasty complications (CADILLAC) trial J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1215 - 1223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. O. Costantini, G. W. Stone, R. Mehran, E. Aymong, C. L. Grines, D. A. Cox, T. Stuckey, M. Turco, B. J. Gersh, J. E. Tcheng, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 305 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Gibson and A. Schomig Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion Circulation, June 29, 2004; 109(25): 3096 - 3105. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Leoncini, F. Bellandi, R. Sciagra, M. Maioli, A. Toso, A. Coppola, S. Sestini, A. Mennuti, R. P. Dabizzi, and A. Pupi Gated SPECT Evaluation of the Relationship Between Admission Troponin I, Myocardial Salvage, and Functional Recovery in Acute Myocardial Infarction Treated by Abciximab and Early Primary Angioplasty J. Nucl. Med., May 1, 2004; 45(5): 739 - 744. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bax, R. J. de Winter, C. E. Schotborgh, K. T. Koch, M. Meuwissen, M. Voskuil, R. Adams, K. J. J. Mulder, J. G. P. Tijssen, and J. J. Piek Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 534 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Roe, C. L. Green, R. P. Giugliano, C. M. Gibson, K. Baran, M. Greenberg, S. T. Palmeri, S. Crater, K. Trollinger, K. Hannan, et al. Improved speed and stability of st-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute st-segment elevation myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 549 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Limbruno, A. Micheli, M. De Carlo, G. Amoroso, R. Rossini, C. Palagi, V. Di Bello, A. S. Petronio, G. Fontanini, and M. Mariani Mechanical Prevention of Distal Embolization During Primary Angioplasty: Safety, Feasibility, and Impact on Myocardial Reperfusion Circulation, July 15, 2003; 108(2): 171 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Zimetbaum and M. E. Josephson Use of the Electrocardiogram in Acute Myocardial Infarction N. Engl. J. Med., March 6, 2003; 348(10): 933 - 940. [Full Text] [PDF]
|
|