Impact of Myocardial Blush Grade on In-Hospital Outcome after Primary Percutaneous Coronary Intervention
M M Arefin1, A Rahman, S K Kundu
1Dr Md Minhaj Arefin, Assistant Registrar, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh;
Insights
Assessing myocardial blush grade (MBG) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is crucial. Low MBG indicates incomplete reperfusion and predicts worse in-hospital outcomes, even with TIMI 3 flow.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Primary percutaneous coronary intervention (PPCI) is the standard reperfusion therapy for ST-elevation myocardial infarction (STEMI).
- Myocardial tissue-level perfusion, assessed by Myocardial Blush Grade (MBG), can be suboptimal despite successful TIMI 3 flow post-PPCI.
- Suboptimal MBG is linked to adverse clinical outcomes in STEMI patients.
Purpose of the Study:
- To investigate the association between Myocardial Blush Grade (MBG) and in-hospital outcomes in STEMI patients undergoing primary PCI.
- To determine if MBG is an independent predictor of adverse outcomes after PPCI.
Main Methods:
- A prospective observational study included 74 STEMI patients who achieved TIMI 3 flow after PPCI.
- Patients were divided into low MBG (grade 0-1) and high MBG (grade II-III) groups.
- Clinical characteristics, procedural data, and in-hospital complications were analyzed.
Main Results:
- The low MBG group had significantly higher rates of smoking, diabetes mellitus, multi-vessel involvement, and anterior MI.
- Left ventricular ejection fraction (LVEF) was significantly lower in the low MBG group.
- Acute heart failure, total adverse in-hospital outcomes, and mortality were significantly higher in the low MBG group.
Conclusions:
- Low Myocardial Blush Grade (MBG) is an independent predictor of adverse in-hospital outcomes following primary PCI in STEMI patients.
- Assessing MBG alongside TIMI 3 flow is essential for evaluating complete reperfusion and predicting patient outcomes.
- These findings highlight the importance of optimizing myocardial perfusion beyond epicardial flow restoration.
Abstract:
Primary percutaneous coronary intervention (PPCI) is the optimal reperfusion strategy in patients with ST elevation Myocardial Infarction (STEMI). However, despite achieving TIMI 3 flow after PPCI, some patients have less optimal perfusion at the myocardial tissue level, as assessed by Myocardial Blush Grade (MBG) and consequently show adverse outcome. This prospective observational study was performed in the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from March 2016 to February 2017. Total 74 patients with STEMI who underwent primary PCI and achieved TIMI 3 flow were included among them 37 patients were taken with low MBG (grade 0 or 1) in Group I and other 37 patients with high MBG (grade II or III) were taken in Group II. Mean age of Group I and Group II were 53.70±9.17 and 51.49±9.41 years respectively (p=0.536). Male to female ratio was 5.7:1. Smoking (59.5% versus 35.1%, p=0.036) and diabetes mellitus (43.2% versus 18.9%, p=0.024) were significantly higher in low MBG group than high MBG group. Multi vessel involvement (24.3% versus 5.4%, p=0.022) and anterior MI (72.9% versus 51.4%, p=0.047) were significantly higher in low MBG group. LVEF was significantly lower in low MBG group than high MBG group (49.92?6.60% versus 58.84?4.55%, p=0.003). Among the complications acute heart failure was found significantly higher in low MBG group than high MBG group (8.1% versus 0.0%, p=0.048) along with total adverse in hospital outcome (24.3% versus 5.4%, p=0.041). In study population total mortality was 2.7% and all were in low MBG group (5.4%). Multivariate logistic regression analysis showed MBG was an independent predictor of adverse in hospital outcome after PPCI (OR 6.553, 95% CI 1.984-21.643, p=0.002). Low MBG is associated with more adverse in hospital outcome after PPCI. So, along with TIMI 3 flow following PPCI we have to assess MBG for evaluation of complete reperfusion and further outcome.
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