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Distribution and determinants of myocardial perfusion grade following late mechanical recanalization of occluded infarct‐related arteries postmyocardial infarction: A report from the occluded artery trial
Author(s) -
Jorapur Vinod,
Steigen Terje K.,
Buller Christopher E.,
Dẑavík Vladimír,
Webb John G.,
Strauss Bradley H.,
Yeoh Eunice E.S.,
Kurray Peter,
Sokalski Leszek,
Machado Mauricio C.,
Kronsberg Shari S.,
Lamas Gervasio A.,
Hochman Judith S.,
Mancini G.B. John
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21745
Subject(s) - medicine , cardiology , timi , myocardial infarction , ejection fraction , conventional pci , blood pressure , percutaneous coronary intervention , coronary arteries , artery , heart failure
Abstract Objective: To evaluate the distribution and determinants of myocardial perfusion grade (MPG) following late recanalization of persistently occluded infarct‐related arteries (IRA). Background: MPG reflects microvascular integrity. It is an independent prognostic factor following myocardial infarction, but has been studied mainly in the setting of early reperfusion. The occluded artery trial (OAT) enrolled stable patients with persistently occluded IRAs beyond 24 hr and up to 28 days post‐MI. Methods: Myocardial blush was assessed using TIMI MPG grading in 261 patients with TIMI 3 epicardial flow following IRA PCI. Patients demonstrating impaired (0–1) versus preserved (2–3) MPG were compared with regard to baseline clinical and pre‐PCI angiographic characteristics. Results: Impaired MPG was observed in 60 of 261 patients (23%). By univariate analysis, impaired MPG was associated with failed fibrinolytic therapy, higher heart rate, lower systolic blood pressure, lower ejection fraction, LAD occlusion, absence of collaterals ( P < 0.01) and ST elevation MI, lower diastolic blood pressure, and higher systolic sphericity index ( P < 0.05). By multivariable analysis, higher heart rate, LAD occlusion, absence of collaterals and higher systolic sphericity index ( P < 0.01), and lower systolic blood pressure ( P < 0.05) were independently associated with impaired MPG. Conclusion: Preserved microvascular integrity was present in a high proportion of patients following late recanalization of occluded IRAs post‐MI. Presence of collaterals was independently associated with preserved MPG and likely accounted for the high frequency of preserved myocardial perfusion in this clinical setting. Impaired MPG was associated with baseline clinical and angiographic features consistent with larger infarct size. © 2008 Wiley‐Liss, Inc.