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Published on: February 10, 2012
Coronary clearance frame count: a new index of microvascular perfusion
Armando Perez de Prado1, Felipe Fernández-Vázquez, J Carlos Cuellas-Ramón
1Department of Cardiology, Hospital de León, León, Spain. aperez@secardiologia.es
Background:
The angiographic data of myocardial perfusion obtained following direct angioplasty in acute myocardial infarction (AMI) can be evaluated only by qualitative methods: the myocardial blush grade (MBG) or the TIMI myocardial perfusion grade (TMPG). To minimize the subjective nature of this evaluation, we describe a quantitative index, the "coronary clearance frame count" (CCFC); and have tested it against known indices.
Methods:
All patients with AMI treated with direct angioplasty in a single center over 2 years were prospectively analyzed. All films were assessed off-line to determine the traditional indices of TIMI flow grade, TIMI frame count, MBG and TMPG. To define CCFC, we used the first frame in which the contrast is cleared from the ostium of the artery as "frame 0" and that in which contrast begins to wash-in into the same coronary artery distal landmark proposed by TIMI Group, as the "last frame".
Results:
Of the 147 patients studied, 110 had films that were technically adequate for measuring qualitative and quantitative indices of myocardial perfusion. CCFC showed a good correlation with MBG (p=0.045) and with TMPG (p<0.001). CCFC was strongly related to the presence of TMPG 2 or 3 (p<0.001). A cut-off value of 45 frames has a sensitivity of 75% and specificity of 70% to predict a TMPG 2 or 3.
Conclusion:
Coronary clearance frame count has a good correlation with known indices of reperfusion and has the advantage of being an objective, quantitative index that is efficient even in inexperienced hands. Abbreviated Abstract. The angiographic quality of myocardial perfusion data obtained following direct angioplasty in acute myocardial infarction can only be evaluated by qualitative methods: the myocardial blush grade or the TIMI myocardial perfusion grade. To minimize the subjective nature of these methods, we describe a quantitative index (the "coronary clearance frame count") which we evaluated against the other well-established indices, and have observed it to be efficient even in the hands of inexperienced practitioners.
Insights
A new quantitative index, coronary clearance frame count (CCFC), accurately measures myocardial perfusion after acute myocardial infarction angioplasty. CCFC offers an objective alternative to subjective qualitative methods, proving efficient even for less experienced practitioners.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Assessing myocardial perfusion after acute myocardial infarction (AMI) angioplasty traditionally relies on subjective qualitative methods like myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMPG).
- The inherent subjectivity of qualitative assessments can limit their reliability and consistency in clinical practice.
- There is a need for objective, quantitative measures to evaluate myocardial perfusion post-angioplasty in AMI.
Purpose of the Study:
- To introduce and validate a novel quantitative index, the coronary clearance frame count (CCFC), for assessing myocardial perfusion in AMI.
- To compare the CCFC with established qualitative indices (MBG and TMPG) to determine its correlation and predictive value.
- To evaluate the efficiency and objectivity of CCFC, particularly in the context of varying practitioner experience.
Main Methods:
- A prospective analysis of patients undergoing direct angioplasty for AMI over two years.
- Angiographic films were assessed offline to determine traditional indices: TIMI flow grade, TIMI frame count, MBG, and TMPG.
- The CCFC was defined using specific contrast clearance and wash-in frames from the coronary artery ostium to a distal landmark.
Main Results:
- Out of 147 patients, 110 had technically adequate films for analysis.
- CCFC demonstrated a significant correlation with both MBG (p=0.045) and TMPG (p<0.001).
- A CCFC cut-off value of 45 frames showed 75% sensitivity and 70% specificity in predicting a TMPG of 2 or 3, indicating strong predictive capability.
Conclusions:
- The coronary clearance frame count (CCFC) is a reliable quantitative index for assessing myocardial perfusion.
- CCFC shows good correlation with established reperfusion indices and offers an objective alternative to subjective qualitative methods.
- The CCFC is efficient and potentially valuable even for practitioners with less experience in interpreting myocardial perfusion.
