From the Department of Cardiology, Hospital De Weezenlanden, Zwolle, the
Netherlands.
Correspondence to Dr Felix Zijlstra, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Background—The primary objective of
reperfusion therapies for acute myocardial infarction is not only
restoration of blood flow in the epicardial coronary artery but
also complete and sustained reperfusion of the infarcted part of
the myocardium.
Methods and Results—We studied 777 patients who underwent primary
coronary angioplasty during a 6-year period and investigated
the value of angiographic evidence of myocardial reperfusion
(myocardial blush grade) in relation to the extent of ST-segment
elevation resolution, enzymatic infarct size, left
ventricular function, and long-term mortality. The
myocardial blush immediately after the angioplasty procedure was graded
by two experienced investigators, who were otherwise blinded to all
clinical data: 0, no myocardial blush; 1, minimal myocardial blush; 2,
moderate myocardial blush; and 3, normal myocardial blush. The
myocardial blush was related to the extent of the early ST-segment
elevation resolution on the 12-lead ECG. Patients with blush grades 3,
2, and 0/1 had enzymatic infarct sizes of 757, 1143, and 1623
(P<0.0001), respectively, and ejection fractions of
50%, 46%, and 39%, respectively (P<0.0001). After a
mean±SD follow-up of 1.9±1.7 years, mortality rates of patients with
myocardial blush grades 3, 2, and 0/1 were 3%, 6%, and 23%
(P<0.0001), respectively. Multivariate
analysis showed that the myocardial blush grade was a predictor
of long-term mortality, independent of Killip class,
Thrombolysis In Myocardial Infarction grade flow, left
ventricular ejection fraction (LVEF), and other clinical
variables.
Conclusions—In patients after reperfusion therapy, the myocardial
blush grade as seen on the coronary angiogram can be used to
describe the effectiveness of myocardial reperfusion and is an
independent predictor of long-term mortality.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Angiographic Assessment of Myocardial Reperfusion in Patients Treated With Primary Angioplasty for Acute Myocardial Infarction
Myocardial Blush Grade
Key Words: myocardial infarction • angioplasty • angiography
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