Operator versus core laboratory assessment of angiographic reperfusion markers in patients undergoing primary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush Grade (MBG) are crucial prognostic indicators in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
• The concordance and relative prognostic value of operator (Op) versus angiography core laboratory (ACL) assessments for TIMI flow and MBG remain unclear.

Purpose of the Study:

• To evaluate the agreement between operator and angiography core laboratory assessments of TIMI flow and MBG in STEMI patients.
• To determine the relative prognostic utility of these assessments for predicting 3-year mortality after primary PCI.

Main Methods:

• Analysis of data from the Harmonizing Outcomes with RevascularIZatiON and Stents in AMI (HORIZONS-AMI) trial, including 3345 patients undergoing primary PCI.
• Comparison of baseline and final TIMI flow and MBG assessments by operators and ACL using Cohen's kappa coefficient.
• Assessment of 3-year survival rates in relation to discordant and concordant TIMI flow and MBG scores.

Main Results:

• Agreement between Op and ACL was moderate for pre-PCI TIMI flow (κ=0.51) and fair for post-PCI MBG (κ=0.20).
• Discordance was observed in 12.9% of patients for final TIMI flow and 22.4% for final MBG.
• Operators tended to assign more favorable grades than ACL, particularly when ACL results were unfavorable.
• Both Op and ACL assessments of TIMI 3 flow and MBG 2-3 strongly correlated with improved 3-year survival (P<0.0001).

Conclusions:

• Operator and ACL assessments of angiographic reperfusion markers in STEMI show fair to moderate agreement.
• Operator assessments may tend to favorably interpret ACL results.
• Despite agreement variations, both operator and ACL assessments of reperfusion are valuable for predicting long-term mortality.