[Limitations of myocardial blush grade in the evaluation of myocardial perfusion in patients with acute myocardial infarction and TIMI grade 3 flow].
OBJECTIVE
An analysis was made of variability in the measurement of the angiographic index blush between a university hospital and an independent core laboratory, as well as its correlation with perfusion analyzed by intracoronary myocardial contrast echocardiography (MCE) and the ventricular function at the sixth month.


METHODS
The study comprised 40 patients with a first ST-segment elevation myocardial infarction, single-vessel disease and open infarct-related artery. Perfusion was quantified by angiography (median fifth day, range 3-7) with blush in our laboratory and in an independent core laboratory. MCE was performed. Ejection fraction at the sixth month was determined with magnetic resonance imaging.


RESULTS
We found a weak correlation (r=0.38) between both laboratories. In the comparison of blush measurements concordance was 80%, kappa=0.43 if normality was defined by blush 2-3; and concordance 55%, kappa=0.1 for blush 3. Neither perfusion analyzed by MCE (r= 0.23, P=.2) nor ejection fraction by resonance (r=0.20, P=.3) did correlate to blush.


CONCLUSIONS
After infarction in patients with TIMI 3, variability is observed in blush measurements between a university hospital and an independent core laboratory, therefore it seems advisable to centralize blush measures in highly specialized core laboratories. A weak correlation was detected with perfusion analyzed by MCE and with late systolic function.
Bertomeu-González
Vicente
V
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Blasco Ibáñez 17, 46010 Valencia, Spain.
Bodí
Vicent
V
Sanchis
Juan
J
Núñez
Julio
J
López-Lereu
María P
MP
Peña
Gonzalo
G
Losada
Antonio
A
Gómez
Cristina
C
Chorro
Francisco J
FJ
Llàcer
Angel
A
D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D015425:Myocardial Reperfusion; D013318:Stroke Volume; D015912:Thrombolytic Therapy