title: Myocardial blush grade: a predictor for major adverse cardiac events after primary PTCA with stent implantation for acute myocardial infarction.
abstract: OBJECTIVE
  Optimal myocardial reperfusion is of great importance for survival of patients with AMI undergoing PTCA. According to the Thrombolysis In Myocardial Infarction (TIMI) 3 score, restoration of epicardial flow is achieved in the majority of patients. However, the myocardial blush grade (MBG) may offer additional information for survival. Therefore, we sought to determine whether myocardial blush grades were associated with MACE during follow-up in a high-risk AMI population undergoing primary PTCA with stent implantation.
  
  
  METHODS
  Hundred-and-thirty patients with AMI underwent PTCA with stent implantation from 1999 to 2004. The clinical, angiographic and follow-up data were extracted from the hospital records. Apart from the availability and technical adequacy of the angiograms for angiographic analysis, there were no exclusion criteria.
  
  
  RESULTS
  Post-procedural TIMI 3 flow was achieved in 103 (79%) patients, while MBG-3 was observed in only 44 (34%) patients. Less post-intervention AMI, cardiac deaths or any MACE occurred in patients with MBG 3 (4/44) compared with MBG 1 or 2 (36/86) (P < 0.01). MBG 3 was a strong predictor of absence of MACE during 5-year follow-up (P < 0.01), whereas no association was found between TIMI 3 and event-free survival (P > 0.5) in our population.
  
  
  CONCLUSIONS
  Our data show that (1) MBG 3 is an important marker for survival and (2) the predictive value of MBG is superior to the TIMI flow grades. Given the predictive validity of MBG shown for MACE-free survival and low rate of MBG 3 despite achievement of TIMI 3 flow, a prospective study with adjunctive therapies to enhance myocardial perfusion is warranted.
authors.affiliation: Department of Cardiology, Gazi University Medical School, Ankara, Turkey.
authors.forename: Mehmet G
authors.initials: MG
authors.lastname: Kaya
authors.forename: Fatih
authors.initials: F
authors.lastname: Arslan
authors.forename: Adnan
authors.initials: A
authors.lastname: Abaci
authors.forename: Geert
authors.initials: G
authors.lastname: van der Heijden
authors.forename: Timur
authors.initials: T
authors.lastname: Timurkaynak
authors.forename: Atiye
authors.initials: A
authors.lastname: Cengel
mesh_terms: D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015425:Myocardial Reperfusion; D009206:Myocardium; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome