Comparison of two visual angiographic perfusion grades in acute myocardial infarction

Introduction. Prognosis after opening the obstructed coronary artery in acute myocardial infarction (AMI) is influenced by several factors. In routine clinical practice, revascularization is considered to be successful when the restoration of epicardial blood-flow is complete. However, the patent epicardial artery does not always provide functional recovery in the myocardium. There are two visual angiographic grades to assess myocardial perfusion: myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMP). The aim of our study was to compare these two parameters, how they correlate with short-term indicators of myocardial damage. Patients and methods. The two visual grades were assessed along with enzymatic infarct size as creatine kinase release (CK), echocardiographic left ventricular ejection fraction (LVEF), and ST-segment resolution (STR) in 62 patients with acute myocardial infarction and successful revascularization. Results. Better correlation was found with TMP in case of all clinical parameters (CK: R= - 0.687, P0.001; LVEF: R=0.586, P0.001; STR: R=0.574, P0.001). MBG also showed significant correlations with clinical measurements, except for enzymatic infarct size (CK: R=- 0.062, P=0.626; LVEF: R=0.389, P=0.002; STR: R=0.348, P=0.006). Conclusion. Our findings suggest that the clearance of the dye (described by TMP) is more characteristic to myocardial recovery after AMI, than maximal contrast density (described by MBG) in the clinical practice.