title: Operator versus core laboratory assessment of angiographic reperfusion markers in patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.
abstract: BACKGROUND
  Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush Grade (MBG) are important prognostic indicators before and after primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction; however, the concordance and relative prognostic utility of operator (Op) versus angiography core laboratory (ACL) assessed TIMI flow and MBG are unknown.
  
  
  RESULTS
  Baseline and final Op and ACL TIMI flow and MBG assessment were compared from the Harmonizing Outcomes with RevascularIZatiON and Stents in AMI trial in 3345 patients undergoing primary PCI using Cohen's κ coefficient. κ Was highest for pre-PCI TIMI flow (0.51, representing moderate agreement) and lowest for post-PCI MBG (0.20, representing fair agreement). Discordance between Op and ACL for final TIMI flow (0 to 2 versus 3) occurred in 12.9% of patients and for final MBG (0 to 1 versus 2 to 3) in 22.4%. Among 415 patients with final TIMI flow 0 to 2 by ACL, Op scoring was TIMI flow 3 in 267 (64.3%). Similarly, among 706 patients with final MBG 0 to 1 by ACL, 563 (79.7%) were classified as MBG 2 to 3 by Op. Post-PCI TIMI 3 flow and MBG 2 to 3 strongly correlated with 3-year survival, as assessed by both Op and ACL (P<0.0001). Mortality was intermediate in patients in whom ACL and Op were discordant, without marked prognostic differences between the discordant groups.
  
  
  CONCLUSIONS
  Op and ACL assessment of angiographic markers of reperfusion in ST-segment-elevation myocardial infarction demonstrates fair to moderate agreement. Op tended to favorably grade unfavorable ACL results. Nonetheless, both Op and ACL assessment of reperfusion strongly inform prediction of 3-year mortality.
authors: Cardiac Catheterization Laboratory, New York Methodist Hospital, 506 6th St, Brooklyn, NY 11215, USA. sjb9005@nyp.org
authors: Sorin J
authors: SJ
authors: Brener
authors: Ecaterina
authors: E
authors: Cristea
authors: Alexandra J
authors: AJ
authors: Lansky
authors: Martin
authors: M
authors: Fahy
authors: Roxana
authors: R
authors: Mehran
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D000991:Antithrombins / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data*; D003326:Coronary Circulation / Q000502:physiology; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015588:Observer Variation; D017239:Paclitaxel / Q000627:therapeutic use; D010446:Peptide Fragments / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011994:Recombinant Proteins / Q000008:administration & dosage; D050257:Tubulin Modulators / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D050257:Tubulin Modulators; D006493:Heparin; D017239:Paclitaxel; C074619:bivalirudin