European Heart Journal Advance Access originally published online on February 25, 2005
European Heart Journal 2005 26(7):667-674; doi:10.1093/eurheartj/ehi167
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Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction
1The Mayo Clinic and Mayo Foundation, Rochester, MN, USA
2Columbia University Medical Centre and the Cardiovascular Research Foundation, 55E. 59th St, 6th floor, New York City, NY 10022, USA
3Beth Israel Deaconess Medical Centre, Boston, MA, USA
4Mid Carolina Cardiology, Charlotte, NC, USA
5Hospital Gregorio Marañón, Madrid, Spain
6Duke University Medical Centre, Durham, NC, USA
7William Beaumont Hospital, NY, USA
Received 1 November 2005; revised 23 December 2004; accepted 13 January 2004; online publish-ahead-of-print 25 February 2005.
* Corresponding author. Tel: +1 212 434 6304; fax: +1 212 4343 6396. E-mail address: gstone{at}crf.org
See page 634 for the editorial comment on this article (doi:10.1093/eurheartj/ehi217)
Aims ST-segment recovery (
STR) and myocardial blush (MB) evaluate different elements of microcirculatory integrity after reperfusion therapy in acute myocardial infarction (AMI). We sought to determine whether the combination of STR and MB after primary percutaneous coronary intervention (PCI) in AMI has greater prognostic utility than either measure alone.
Methods and results The 30 days and 1 year clinical outcomes of 456 patients were assessed as a function of STR and MB after primary PCI from the CADILLAC trial. STR and MB were concordant (
70% STR and MB grade 2/3 or <70% STR and MB grade 0/1) in 60.1% of patients and discordant in 39.9% of patients. The greatest survival was observed among patients with complete STR (70%) and MB grade 2/3 in whom the cumulative rates of death at 30 days and 1 year were 0.6 and 1.2%, respectively. Poorest survival was observed among patients with incomplete STR (<70%) and reduced MB (grade 0/1), in whom 30 days and 1 year rates of death were 8.3 and 10.1%, respectively. Intermediate outcomes were present in patients with discordant MB and STR. By multivariable analysis, however, STR was an independent correlate of survival at 30 days and 1 year (P=0.05 and 0.01, respectively), whereas MB was no longer predictive (P=0.38 and 0.72, respectively).
Conclusion STR and MB are not infrequently discordant after primary PCI. By univariate analysis, both measures of reperfusion success strongly correlate with survival and assessment of both yields incremental prognostic information beyond either measure alone. By multivariable analysis, however, STR is the stronger prognostic variable.
Key Words: Microcirculation • Myocardial infarction • Prognosis
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