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European Heart Journal Advance Access published online on February 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi167
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction

Paul Sorajja 1, Bernard J. Gersh 1, Costantino Costantini 2, Michael G. McLaughlin 3, Peter Zimetbaum 3, David A. Cox 4, Eulogio Garcia 5, James E. Tcheng 6, Roxana Mehran 2, Alexandra J. Lansky 2, David E. Kandzari 6, Cindy L. Grines 7, and Gregg W. Stone 2*

1 The Mayo Clinic and Mayo Foundation, Rochester, MN, USA
2 Columbia University Medical Centre and the Cardiovascular Research Foundation, 55E. 59th St, 6th floor, New York City, NY 10022, USA
3 Beth Israel Deaconess Medical Centre, Boston, MA, USA
4 Mid Carolina Cardiology, Charlotte, NC, USA
5 Hospital Gregorio Marañón, Madrid, Spain
6 Duke University Medical Centre, Durham, NC, USA
7 William Beaumont Hospital, NY, USA

* To whom correspondence should be addressed.
Gregg W. Stone, E-mail: gstone{at}crf.org


  Abstract

Aims ST-segment recovery ({Sigma}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 {Sigma}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 {Sigma}STR and MB after primary PCI from the CADILLAC trial. {Sigma}STR and MB were concordant (≥70% {Sigma}STR and MB grade 2/3 or <70% {Sigma}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 {Sigma}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 {Sigma}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 {Sigma}STR. By multivariable analysis, however, {Sigma}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 {Sigma}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, {Sigma}STR is the stronger prognostic variable.

Keywords: Microcirculation; Myocardial infarction; Prognosis.
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