title: Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction.
abstract: OBJECTIVE
  We sought to evaluate and validate the ability of the angiographic myocardial blush grade to risk stratify patients after successful angioplasty in acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Although epicardial Thrombolysis In Myocardial Infarction (TIMI)-3 flow is restored in >90% of patients undergoing primary percutaneous coronary intervention (PCI), normal myocardial perfusion may be present less frequently and may detrimentally impact survival.
  
  
  METHODS
  A cohort of 173 consecutive patients undergoing intervention within 24 h of AMI onset were studied. High-risk features of this population included failed thrombolysis in 39%, cardiogenic shock in 17% and saphenous vein graft culprit in 11% of patients.
  
  
  RESULTS
  Despite the restoration of TIMI-3 flow in 163 (94.2%) patients, myocardial perfusion, as evidenced by normal contrast opacification of the myocardial bed subtended by the infarct artery (myocardial blush), was normal in only 29.4% of patients with TIMI-3 flow following PCI, and in no patient with TIMI 0 to 2 flow. In patients in whom TIMI-3 flow was restored, survival was strongly dependent on the myocardial perfusion grade; one-year cumulative mortality was 6.8% with normal myocardial blush, 13.2% with reduced myocardial blush and 18.3% in patients with absent myocardial blush (p = 0.004).
  
  
  CONCLUSIONS
  Abnormal myocardial perfusion is present in most patients following primary or rescue PCI in AMI, despite restoration of brisk epicardial coronary flow. In high risk patients achieving TIMI-3 flow after intervention, the myocardial blush score may be used to stratify prognosis into excellent, intermediate and poor survival. Further study is warranted to examine whether adjunctive mechanical or pharmacologic strategies can further improve myocardial perfusion and survival of patients with acute myocardial infarction undergoing intervention.
authors.affiliation: Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA. gstone@crf.org
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Michael A
authors.initials: MA
authors.lastname: Peterson
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion; D015203:Reproducibility of Results; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome