Comparison of two visual angiographic perfusion grades in acute myocardial infarction

Abstract

IntroductionPrognosis after opening the obstructed coronary artery in acute myocardial infarction (AMI) is influenced by several factors. In routine clinical practice, revascularization is considered to be successful when the restoration of epicardial blood-flow is complete. However, the patent epicardial artery does not always provide functional recovery in the myocardium. There are two visual angiographic grades to assess myocardial perfusion: myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMP). The aim of our study was to compare these two parameters, how they correlate with short-term indicators of myocardial damage.Patients and methodsThe two visual grades were assessed along with enzymatic infarct size as creatine kinase release (CK), echocardiographic left ventricular ejection fraction (LVEF), and ST-segment resolution (STR) in 62 patients with acute myocardial infarction and successful revascularization.ResultsBetter correlation was found with TMP in case of all clinical parameters (CK: R= − 0.687, P<0.001; LVEF: R=0.586, P<0.001; STR: R=0.574, P<0.001). MBG also showed significant correlations with clinical measurements, except for enzymatic infarct size (CK: R=− 0.062, P=0.626; LVEF: R=0.389, P=0.002; STR: R=0.348, P=0.006).ConclusionOur findings suggest that the clearance of the dye (described by TMP) is more characteristic to myocardial recovery after AMI, than maximal contrast density (described by MBG) in the clinical practice.

TIMI Myocardial Perfusion Grade and ST-segment resolution in the assessment of coronary reperfusion after primary angioplasty

“…A relatively weak (r = 0.24) but significant correlation between TMPG and summed relative ST segment resolution was seen after thrombolytic treatment [11]. A better correlation (r = 0.58) was reported between TMPG and relative ST segment resolution in a single lead in patients treated invasively [12]. Other authors showed significantly more frequent occurrence of more than 50% ST segment resolution after pPCI in patients with TMPG 2 or 3 [13].…”

Quantitative myocardial blush score (QuBE) allows the prediction of heart failure development in long-term follow-up in patients with ST-segment elevation myocardial infarction: Proof of concept study

“…Furthermore, Bertomeu--Gonzalez et al [10] have raised the question on inter-observer variability of MBG assessment, have reported on a lack of correlation between MBG and LVEF assessed with magnetic resonance imaging (MRI). Authors of additional studies point out superior performance of TIMI myocardial perfusion scale (TMP) over MBG in correlation with other indices of myocardial perfusion [1,11].…”