Abstract 1681: Evaluation of Quantitative Myocardial Perfusion MRI and TIMI myocardial blush grade (Blush score)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hiroshi Nakajima ◽  
Shinya Okamoto ◽  
Hajime Sakuma ◽  
Tairo Kurita ◽  
Motonori Nagata ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Area Under The Curve ◽  
Primary Angioplasty ◽  
Perfusion Mri ◽  
St Segment Elevation ◽  
Quantitative Perfusion ◽  
Timi Grade ◽  
Significant Difference ◽  
Myocardial Blush Grade

Background: The TIMI myocardial blush grade (MBG) has been shown to be a strong angiographic predictor of mortality in patients with TIMI 3 flow after primary angioplasty. This study was conducted to evaluate the relationship between regional myocardial perfusion quantified by cardiac magnetic resonance and angiographic reperfusion score defined by MBG. Methods: We studied 29 consecutive patients (25 men, age 63±13 years) with ST-segment elevation acute myocardial infarction (LAD lesion: 12, RCA lesion: 16, LCx lesion: 2) who underwent primary angioplasty within 6 hours from the onset and showed TIMI grade 3. MBG was determined on angiography at the end of angioplasty. All patients underwent rest myocardial perfusion MRI during initial hospitalization, and regional MBF (ml/min/g) was quantified by using a Patlak plot method. Myocardial perfusion (MP) ratio was calculated from quantitative perfusion MRI, as MBF in infarction area/MBF in normal area. The optimal cut-off value of MP ratio that can predict MBG 3 on coronary angiography was determined by using a receiver-operating characteristic (ROC) analysis. Results: In 29 patients with TIMI 3 flow after angioplasty, 4 patients had MBG 0–1, 7 had MBG 2 and 18 had MBG 3. The MP ratio in MBG 3 group calculated from quantitative perfusion MRI was significantly higher than the MP ratios in MBG 0 –1 group and MBG 2 group (0.96±0.18 vs. 0.48±0.25, P<0.001; 0.96±0.18 vs. 0.66±0.19, P=0.003, respectively). There was no significant difference between the MP ratios in MBG 0 –1 group and MBG 2 group. The ROC curve revealed that MP ratio of 0.74 is an optimal threshold to distinguish MBG 3 from MBG 0 –2, with a high area under the curve of 0.90. Conclusions: The result of this study demonstrates that MP ratio quantified from rest perfusion MRI correlated well with MBG on coronary angiography.

scholarly journals Thrombus Aspiration Plus Intracoronary Abciximab vs Intracoronary Abciximab Alone in Patients with STEMI Undergoing Primary PCI

2019 ◽  
pp. 1-10
Author(s):  
Prem Krishna Anandan ◽  
K. Tamilarasu ◽  
G. Rajendran ◽  
Shanmuga Sundaram ◽  
P. Ramasamy ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Cardiovascular Mortality ◽  
Combination Group ◽  
Primary Pci ◽  
Thrombus Aspiration ◽  
Aspiration Thrombectomy ◽  
St Segment Elevation ◽  
St Segment ◽  
Secondary Endpoints ◽  
Myocardial Blush Grade

Background: Thrombus embolization during the Percutaneous Coronary Intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI is bolus intracoronary Abciximab and manual aspiration thrombectomy. There are several factors which influence the decision of primary PCI in a patient with AMI in developing countries. Cost of therapy and affordability is probably the most important factor. The additional cost for thrombus aspiration needs to be considered against the additional advantages in terms of better clinical outcome.  Objectives: To compare the use of a combination of intracoronary Abciximab with manual thrombus aspiration to intracoronary Abciximab alone, in patients with STEMI undergoing primary PCI. Patients and Methods:  This is a prospective observational study of patients with STEMI who underwent primary PCI between June 2018 to May 2019. A pre-approved study protocol was designed to determine the eligibility of STEMI patients to be included in the study. Patients with The patients have analysed in two groups: 84 patients received a combination of intracoronary Abciximab with manual thrombus aspiration  &  80 patients received intracoronary Abciximab alone.  The primary endpoint was the assessment of myocardial perfusion parameters namely Myocardial Blush Grade (MBG) in the culprit vessel & ST-segment resolution of >70% on ECG at 90 min after PCI. Secondary endpoints were the improvement in LV ejection fraction, cardiovascular mortality & recurrent MI at one-month post-procedure.  Results: Result of the 84 patients who received combination of intracoronary Abciximab with manual thrombus aspiration, the primary endpoints namely the myocardial blush grade (MBG) of 2/3 was achieved in 72 patients (90.74%) & ST-segment resolution of >70% at 90 min was seen in 66 patients (78.57%) (p<0.001). Of the 80 patients who received only intracoronary Abciximab without thrombus aspiration, MBG 2/3 was achieved in 38 patients (47.5%) & ST-segment resolution of >70% at 90 min was seen in 28 patients (35%). At one month of follow up the secondary endpoints namely the LVEF in the combination group improved from 43.42±3.73 to 47.88±4.16% (p=0.12)and in the Abciximab group improved from 44.78±3.34 to 46.20±3.63%. Recurrent MI was seen in one patient in the combination group (p<0.001) & two patients in the ic Abciximab group. There was no cardiovascular mortality noted in the present study (p<0.001). Conclusion: Intracoronary Abciximab + manual thrombus aspiration reduces thrombus burden with better results in microvascular perfusion assessed by ST-segment resolution of >70% at 90 min & higher Myocardial Blush Grade compared to intracoronary Abciximab alone in patients with STEMI undergoing primary PCI.

scholarly journals 588 Prognostic impact of early vs. deferred angiography in MINOCA patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Armillotta ◽  
Angelo Sansonetti ◽  
Sara Amicone ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Optimal Timing ◽  
Prognostic Impact ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Aims Although an early invasive strategy (coronary angiography performed &lt;24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (&lt;24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA. Methods and results From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of &lt; 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (&lt;24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography. Conclusions We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.

scholarly journals Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty

2005 ◽  
Vol 26 (7) ◽  
pp. 662-666 ◽  
Author(s):  
Giuseppe De Luca ◽  
Arnoud W.J. van 't Hof ◽  
Jan Paul Ottervanger ◽  
Jan C.A. Hoorntje ◽  
A.T. Marcel Gosselink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Primary Angioplasty ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Comparison of Mean Platelet Volume in Acute Myocardial Infarction vs. Normal Coronary Angiography

2016 ◽  
Vol 8 (11) ◽  
pp. 320 ◽  
Author(s):  
Alireza Rai ◽  
Mohammadreza Saidi ◽  
Nahid Salehi ◽  
Farzad Sahebjamei ◽  
Masoud Jalilian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Platelet Count ◽  
Coronary Angiography ◽  
University Hospital ◽  
Control Group ◽  
Platelet Volume ◽  
St Segment Elevation ◽  
Significant Difference ◽  
Normal Coronary Angiography

<p>Considering the importance of cardiovascular disease and the role that platelets have in thrombosis formation in the coronary arteries, this study was done in order to assess platelet-related indices in patients who suffered acute myocardial infarction (MI) and compare them with those who had normal coronary angiography results.In this descriptive-analytical study, 200 patients who were admitted to our university hospital due to chest pain were included. The patients were divided into five groups including ST-segment elevation MI (STEMI), non-STEMI, unstable angina (UA), stable angina (SA), and healthy subjects (as control group). Platelet-related indices including platelet count as well asmean platelet volume (MPV) was determined. For this purpose, blood samples were taken from the patients upon admission and platelet count and volume were measured within three hours of admission.There was no statistically significant difference regarding MPV between the study groups (P&gt; 0.05).</p><p>MPV did not have any role in diagnosing various types of coronary artery disease (CAD).</p>

scholarly journals CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction

Medicina ◽  
2019 ◽  
Vol 55 (2) ◽  
pp. 35 ◽  
Author(s):  
Ammar Ashoori ◽  
Hamidreza Pourhosseini ◽  
Saeed Ghodsi ◽  
Mojtaba Salarifar ◽  
Ebrahim Nematipour ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Hospital Mortality ◽  
Area Under The Curve ◽  
Primary Angioplasty ◽  
Primary Pci ◽  
Short Term ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
No Reflow ◽  
Risk Stratification Tool

Background and objectives: We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. Materials and Methods: We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. Results: The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30–2.25) and 1.60 (1.17–2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01–1.35), 1.59 (1.28–1.76), and 8.65 (3.76–24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62–0.81). Conclusions: Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.

Impact of adjunctive tirofiban administration on myocardial perfusion and mortality in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction

2005 ◽  
Vol 93 (05) ◽  
pp. 820-823 ◽  
Author(s):  
Giuseppe De Luca ◽  
Jaap Smit ◽  
Nicolette Ernst ◽  
Harry Suryapranata ◽  
Jan Ottervanger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Primary Angioplasty ◽  
Control Group ◽  
Unfavourable Outcome ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Distal Embolisation

SummarySeveral studies have shown that suboptimal myocardial perfusion may be observed despite optimal epicardial recanalisation in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI), resulting in unfavourable outcome. The aim of the current study was to evaluate the benefits in myocardial perfusion and mortality from adjunctive tirofiban administration in patients undergoing primary angioplasty for (STEMI). A total of 1,969 patients with STEMI treated by primary angioplasty represent the population of the current study. All clinical, angiographic and follow-up data were prospectively collected. Tirofiban was administrated in 481 patients (24.4%) (all before angioplasty). Tirofiban was associated with less distal embolisation (11.7% vs 16.1%, p = 0.048), better postprocedural MBG 3 (50.9% vs 39.7%, adjusted p < 0.0001) and a significant reduction in 1-year mortality (3% vs 6.4%, adjusted p = 0.045). The benefits in mortality were confirmed in all subgroups identified according to the quartiles of the propensity score. This study shows that, when compared to control group, adjunctive tirofiban before primary angioplasty for STEMI is associated with better myocardial perfusion and a reduction in 1-year mortality.

Sign in / Sign up

Export Citation Format

Share Document