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European Heart Journal Advance Access originally published online on January 24, 2009
European Heart Journal 2009 30(5):594-599; doi:10.1093/eurheartj/ehn542
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial{dagger}

Mathijs Vogelzang1,2,*, Pieter J. Vlaar1, Tone Svilaas1, Diny Amo3, Maarten W.N. Nijsten2 and Felix Zijlstra1

1 Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
2 Department of Critical Care, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands
3 Cordinamo Independent Core Lab, Wezep, The Netherlands

Received 2 August 2008; revised 8 November 2008; accepted 18 November 2008; online publish-ahead-of-print 24 January 2009.

* Corresponding author. Tel: +31 50 361 61 61, Fax: +31 50 361 43 91, Email: m.vogelzang{at}thorax.umcg.nl

Aims: Myocardial reperfusion after acute myocardial infarction can be angiographically assessed by the myocardial blush grade (MBG) or TIMI Perfusion Grade. These scores are based on subjective human judgement and lead to a score of four categories. A more operator-independent way of scoring myocardial perfusion may facilitate research in this area.

Methods and results: We designed the ‘Quantitative Blush Evaluator’ (QuBE), a computer program which calculates a score for myocardial perfusion. This program will be freely available as open source software. The inter-observer concordance was 97.7%. We calculated values on prospectively collected angiograms in patients with acute ST-elevation myocardial infarction from the TAPAS trial. Quantitative blush evaluator values could be assessed on 790 out of 980 collected angiograms (81%). The QuBE score correlated significantly with MBG as determined by a core lab. The QuBE score predicted complete ST-elevation resolution, low enzyme levels, and 1 year survival (all P < 0.001). Quantitative blush evaluator value was an independent predictor of mortality at 1 year [OR 0.40 (0.17–0.90), P = 0.02].

Conclusion: The QuBE program provides a practical, freely available computer-assisted assessment of myocardial perfusion. The QuBE score provides a useful surrogate endpoint in trials of therapies aimed at improving myocardial reperfusion.

Key Words: Myocardial infarction • Coronary angiography • Blush • Myocardial perfusion • Quantification

{dagger} This is a substudy of the TAPAS trial, Dutch trial register ID NTR914, ISRCTN 16716833.


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