Author + information
- Eustaquio Juan Manos, MD1,
- Guillermo E. Marchetti2,
- Maria Marta Seleme1,
- Jorge Iravedra2,
- Mariano M. Bodoira3,
- Sergio Caldiroli3,
- Julian Kemps3,
- Alejandro Salvatierra4 and
- Antonio Pocovi3
After Primary Angioplasty in acute myocardial infarction (PAAMI), the TIMI of myocardial perfusion grade (TMPG) “myocardial blush”, is a useful but subjective method of microcirculation analysis, with prognostic implications. On the other hand, the addition of complete ST segment resolution (ΣCSTR)>70% is a hard and more objective marker, providing information about tissue level perfusion. We analyzed if exist correlation between TMPG and ΣCSTR in patients with normal epicardial flow TIMI 3.
Material and Methods
From January 2007 to September 2012, we analyzed retrospectively the ECG (at admission and after 30 minutes from angioplasty) and the TMPG from 406 patients (4 centers from Argentina), with PAAMI<12hs, all these patients with normal epicardial flow TIMI 3.The admission Killip and Kimbal was A= 86%, B=11% and D=3%. We evaluated the microcirculation grades like TMPG 3 normal entry and exit of dye from the microvasculature, TMPG 2 delayed entry and exit of dye from the microvasculature, TMPG 1 Dye slowly enters but fails to exit the microvasculature and TMPG 0 failure of dye to enter the microvasculature. We defined: opened microcirculation if TMPG was 2/3 and closed if TMPG was 0/1 at the final result of PAAMI. We considered ΣCSTR, like >70% reduction of ecg after angioplasty, from the initial value at admission. We had 84 patients with mechanical Thrombus Aspiration, 40 cases in TMPG0/1 group and 44 in TMPG2/3.
280/406 patients (68,9%) had ΣCSTR at 30 minutes. Complete ΣCSTR was more significative in patients with opened TMPG 2/3 (240/302, 79,47%) than patients with closed TMPG 0/1 (40/104, 38,4%), in spite of normal coronary epicardial flow; P=0.0004.
Exist direct correlation between ΣCSTR and opened TMPG 2/3. Both methods were useful in the analysis of microcirculation.
|n=406||(TMPG2/3) 302||(TMPG0/1) 104|
|(ΣCSTR) 280||240 (79,47%)||40 (38,4%)|
- 2013 American College of Cardiology Foundation