Henriques Jose P S, Zijlstra Felix, van 't Hof Arnoud W J, de Boer Menko-Jan, Dambrink Jan-Henk E, Gosselink Marcel, Hoorntje Jan C A, Suryapranata Harry
Isala Klinieken, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Circulation. 2003 Apr 29;107(16):2115-9. doi: 10.1161/01.CIR.0000065221.06430.ED. Epub 2003 Apr 14.
Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that optimal angiographic reperfusion is defined by TIMI 3 flow and MBG 2 or 3.
In 924 consecutive patients with TIMI 3 flow after angioplasty for acute myocardial infarction, we prospectively studied the value of MBG. End points were death, MACE, enzymatic infarct size, and residual left ventricular ejection fraction. Follow-up was 16+/-11 months. Of the 924 patients, 101 (11%) patients had MBG 0 or 1. Mortality was significantly higher in patients with MBG 0 or 1 compared with patients with MBG 2 or 3 (relative risk, 4.7; 95% CI, 2.3 to 9.5; P<0.001). The combined incidence of MACE was higher in patients with MBG 0 or 1 compared with patients with MBG 2 or 3 (relative risk, 1.8; 95% CI, 1.1 to 2.8; P=0.009). Enzymatic infarct size was larger (1437+/-2388 versus 809+/-1672, P=0.001) and left ventricular ejection fraction was lower (37.7+/-10.6 versus 43.8+/-11.1, P<0.001) in patients with MBG 0 or 1 compared with patients with MBG 2 or 3.
MBG is a strong angiographic predictor of mortality in patients with TIMI 3 flow after primary angioplasty. Enzymatic infarct size is larger and residual left ventricular ejection fraction is lower in patients with MBG 0 or 1 compared with MBG 2 or 3. Angiographic definition of successful reperfusion should include both TIMI 3 flow as well as MBG 2 or 3.
急性心肌梗死血管造影成功再灌注被定义为TIMI 3级血流。然而，TIMI 3级血流并不总能导致有效的心肌再灌注。心肌 blush 分级（MBG）是心肌灌注的血管造影测量指标。我们假设最佳血管造影再灌注由TIMI 3级血流和MBG 2级或3级定义。
在924例急性心肌梗死血管成形术后TIMI 3级血流的连续患者中，我们前瞻性地研究了MBG的价值。终点为死亡、主要不良心血管事件（MACE）、酶学梗死面积和残余左心室射血分数。随访时间为16±11个月。在924例患者中，101例（11%）患者MBG为0级或1级。与MBG 2级或3级患者相比，MBG 0级或1级患者的死亡率显著更高（相对风险，4.7；95%可信区间，2.3至9.5；P<0.001）。与MBG 2级或3级患者相比，MBG 0级或1级患者的MACE联合发生率更高（相对风险，1.8；95%可信区间，1.1至2.8；P=0.009）。与MBG 2级或3级患者相比，MBG 0级或1级患者的酶学梗死面积更大（1437±2388对809±1672，P=0.001），左心室射血分数更低（37.7±10.6对43.8±11.1，P<0.001）。
MBG是直接血管成形术后TIMI 3级血流患者死亡率的有力血管造影预测指标。与MBG 2级或3级患者相比，MBG 0级或1级患者的酶学梗死面积更大，残余左心室射血分数更低。成功再灌注的血管造影定义应包括TIMI 3级血流以及MBG 2级或3级。
