MYOCARDIAL BLUSH AND ITS ASSOCIATION WITH SUCCESSFUL REPERFUSION IN PATIENTS WITH STEMI UNDERGOING PRIMARY PCI
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Keywords
Myocardial blush, STEMI, Primary PCI, Reperfusion, Angiography, TIMI flow grade
Abstract
Background: Cardiovascular emergencies like ST-segment elevation myocardial infarction (STEMI) need immediate treatment to restore coronary blood flow and reduce myocardial damage. Percutaneous coronary intervention (PCI) is the standard reperfusion treatment. Myocardial blush, an angiographic measure of microvascular perfusion, may predict reperfusion and clinical outcomes.
Aim: The aim of this study is to look at the relationship between myocardial blush and effective reperfusion in a group of 650 STEMI patients having primary PCI.
Study Design, Place and Duration: Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who received primary percutaneous coronary intervention (PCI) at Peshawar Institute of Cardiology between August 2019 and July 2021 were included in this retrospective observational analysis.
Methodology: A retrospective study was carried out on 650 consecutive STEMI patients who received primary PCI between August 2019 and July 2021. Experienced interventional cardiologists assessed angiographic pictures. The TIMI (Thrombolysis in Myocardial Infarction) myocardial perfusion grade system was used to assess myocardial blush. TIMI flow grade 3 in the infarct-related artery after PCI was considered successful reperfusion.
Results: Mean age of the patients was 62.5±10.3 years. Most patients (73.8%) were male. Average time from door to balloon was 45.2±15.8 minutes. Thirty patients (4.6%) exhibited no blush, 80 (12.3%) light, 220 (33.8%) moderate, and 49.2% normal (grade 3). Only 25.0% of mild blush (grade 1) and 68.2% of moderate blush (grade 2) patients achieved effective reperfusion. Successful reperfusion was more likely with myocardial blush compared to lesser blush (grade 1) (OR=2.4, 95% CI=1.3-4.5, p=0.006 and OR=5.8, 95% CI=3.2-10.6, p<0.00 Reperfusion success was higher in older patients (OR=1.1, 95% CI=1.0-1.2, p=0.03). Acute myocardial infarction patients' blush grade and age may indicate reperfusion.
Conclusion: To summarize, our research discovered a robust correlation between the standard myocardial blush grade and achievement of reperfusion in patients with acute MI.
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Anwar Jamal Khan
Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
Nisar Ahmad Khan
Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Muneer Hassan Nawaz
Department of Medicine, St. Columcille’s Hospital Loughlinstown, Dublin, Ireland
Muhammad Bilal Khan
Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
Muhammad Farhan Rasool
Final Year MBBS, Gajju Khan Medical College, Swabi, Pakistan
Sarab Jeet Singh
Department of Medicine, Saidu Group of Teaching Hospitals, Swat, Pakistan
Shah Faisal Khan
Department of Emergency Medicine, Lady Reading Hospital, Peshawar, Pakistan
Shahzaib Iqbal
Department of Medicine, District Headquarter Hospital, Faisalabad, Pakistan