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.
BACKGROUND
ST-segment elevation (SigmaSTe) 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 SigmaSTe 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.


RESULTS
MB grade and SigmaSTe recovery were evaluated shortly after successful primary PTCA (restoration of TIMI grade 3 flow) in 114 consecutive patients with SigmaSTe acute myocardial infarction. LV function was assessed by 2D echocardiograms before PTCA and at 7 days and 6 months thereafter. By combining MB and SigmaSTe changes, 3 main groups of patients were identified. Group 1 patients (n=60) had both significant MB (grade 2 to 3) and SigmaSTe recovery (>50% versus basal SigmaSTe) 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 SigmaSTe, 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 SigmaSTe resolution, had poor early (18%) and late (32%) LV functional recovery.


CONCLUSIONS
After successful primary PTCA, integrated analysis of MB and SigmaSTe recovery allows a real-time grading of microvascular reperfusion of the infarct area and predicts the time-course and magnitude of LV functional recovery.
Division of Cardiology, Ospedale Civile di Legnano, Legnano (MI), Italy. arnaldopoli@hotmail.com
Arnaldo
A
Poli
Raffaela
R
Fetiveau
Pietro
P
Vandoni
Gianfranco
G
del Rosso
Maurizio
M
D'Urbano
Giovanni
G
Seveso
Francesco
F
Cafiero
Stefano
S
De Servi
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome; D016277:Ventricular Function, Left