Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction

Abstract

Aims: ST-segment recovery (2STR) and myocardial blush (MB) evaluate different elements of microcirculatory integrity after reperfusion therapy in acute myocardial infarction (AMI). We sought to determine whether the combination of 2STR and MB after primary percutaneous coronary intervention (PCI) in AMI has greater prognostic utility than either measure alone. Methods and results: The 30 days and 1 year clinical outcomes of 456 patients were assessed as a function of ΣSTR and MB after primary PCI from the CADILLAC trial. ΣSTR and MB were concordant (≥70% ΣSTR and MB grade 2/3 or <70% ΣSTR and MB grade 0/1) in 60.1% of patients and discordant in 39.9% of patients. The greatest survival was observed among patients with complete ΣSTR (≥70%) and MB grade 2/3 in whom the cumulative rates of death at 30 days and 1 year were 0.6 and 1.2%, respectively. Poorest survival was observed among patients with incomplete ΣSTR (<70%) and reduced MB (grade 0/1), in whom 30 days and 1 year rates of death were 8.3 and 10.1%, respectively. Intermediate outcomes were present in patients with discordant MB and 2STR. By multivariable analysis, however, ΣSTR was an independent correlate of survival at 30 days and 1 year (P = 0.05 and 0.01, respectively), whereas MB was no longer predictive (P = 0.38 and 0.72, respectively). Conclusion: ΣSTR and MB are not infrequently discordant after primary PCI. By univariate analysis, both measures of reperfusion success strongly correlate with survival and assessment of both yields incremental prognostic information beyond either measure alone. By multivariable analysis, however, ΣSTR is the stronger prognostic variable. © The European Society of Cardiology 2005. All rights reserved.