title: Prognostic utility of myocardial blush grade after PCI in patients with NSTE-ACS: Analysis from the ACUITY trial.
abstract: OBJECTIVE
  We evaluated the ability of post-procedural myocardial blush grade (MBG) to stratify outcomes of patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTE-ACS).
  
  
  BACKGROUND
  MBG strongly correlates with survival after reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  Of 13,819 NSTE-ACS patients randomized in the ACUITY trial, 3,115 patients underwent PCI and had MBG analyzed by an independent angiographic core laboratory. We examined net adverse clinical events (NACE; composite ischemia or bleeding), composite ischemia (death, MI or ischemia-driven revascularization) and non-CABG major bleeding according to final MBG.
  
  
  RESULTS
  At 30 days, patients with MBG-0/1 had higher rates of NACE (25.1% vs. 13.9%, P = 0.002) and composite ischemia (19.1% vs. 9.4%, P = 0.002) than patients with MBG-2/3. At 1-year follow-up, MBG-0/1 patients had significantly higher rates of composite ischemia compared to other patients (27.8% vs. 19.8%, P = 0.02). By multivariable analysis, MBG-0/1 was an independent predictor of 30-day ischemia-driven revascularization (OR 5.74 [2.63, 12.54], P < 0.0001) in the total population and among patients with normal post-PCI epicardial TIMI-3 flow (OR 6.39 [2.06, 19.78], P = 0.001). However, 1-year outcomes were similar between patients with and without normal myocardial perfusion.
  
  
  CONCLUSIONS
  In conclusion, MBG is a predictor of 30-day revascularization in the overall population and in patients with normal epicardial flow but fails to stratify 1-year outcomes. Thus, unlike in STEMI patients, the prognostic value of MBG in NSTE-ACS patients appears to be limited to the short-term. © 2015 Wiley Periodicals, Inc.
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
authors: Vivian G
authors: VG
authors: Ng
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
authors: Alexandra J
authors: AJ
authors: Lansky
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
authors: Saleem
authors: S
authors: Toro
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
authors: Helen
authors: H
authors: Parise
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University Medical Center, New Haven, Connecticut.
authors: Ecaterina
authors: E
authors: Cristea
authors: Division of Cardiology, Department of Medicine, Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors: Roxana
authors: R
authors: Mehran
authors: Division of Cardiology, Department of Medicine, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000379:methods; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: epicardial blood flow; myocardial blush; non-ST segment elevation myocardial infarction