BACKGROUND: Both epicardial and myocardial perfusion have been associated with clinical outcomes in the setting of ST elevation myocardial infarction (STEMI), and the performance of adjunctive/rescue percutaneous coronary intervention (PCI) may further improve clinical outcomes after fibrinolytic administration. METHODS: The goal was to develop a simple, broadly applicable angiographic metric that takes into account indices of epicardial and myocardial perfusion both before and after PCI to arrive at a single perfusion grade in patients undergoing cardiac catheterization after fibrinolysis. The angiographic perfusion score (APS) is the sum of the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG; 0-3) added to the TIMI myocardial perfusion grade (TMPG; 0-3) before and after PCI (total possible grade, 0-12). Failed perfusion was defined as an APS of 0 to 3, partial perfusion was defined as an APS of 4 to 9, and full perfusion was defined as an APS of 10 to 12. The APS was evaluated in patients from the Double-blind, Placebo-contolled, Multicenter Angiographic Trial of Rhumab CD18 in Acute Myocardial Infarction (LIMIT-AMI; n = 394) and Enoxaparin as Adjunctive Antithrombin Therapy for ST-Elevation Myocardial Infarction-Thrombolysis In Myocardial Infarction (ENTIRE-TIMI) 23 trials (n = 483), and infarct size (120-216 hours after AMI SPECT Technetium-99m Sestamibi data) was assessed in the LIMIT-AMI trial. RESULTS: The APS was associated with the incidence of death or myocardial infarction (failed, 16.7% [n = 18]; partial, 2.5% [n = 155]; full, 2.4% [n = 82]; P =.039 for trend) and larger SPECT infarct sizes (failed, median 39% [n = 10]; partial, 12% [n = 79]; and full, 8% [n = 35]; P =.002). No patient with full APS died, whereas the mortality rate was 11.1% in patients with a failed APS (P =.03). CONCLUSIONS: The APS combines grades of epicardial and tissue level perfusion before and after PCI or at the end of diagnostic cardiac catheterization to arrive at a single angiographic variable that is associated with infarct size and the rates of 30-day death or MI. Partial or full angiographic perfusion scores are associated with a halving of infarct size, and no patients with full angiographic perfusion died.
RCT Entities:
BACKGROUND: Both epicardial and myocardial perfusion have been associated with clinical outcomes in the setting of ST elevation myocardial infarction (STEMI), and the performance of adjunctive/rescue percutaneous coronary intervention (PCI) may further improve clinical outcomes after fibrinolytic administration. METHODS: The goal was to develop a simple, broadly applicable angiographic metric that takes into account indices of epicardial and myocardial perfusion both before and after PCI to arrive at a single perfusion grade in patients undergoing cardiac catheterization after fibrinolysis. The angiographic perfusion score (APS) is the sum of the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG; 0-3) added to the TIMI myocardial perfusion grade (TMPG; 0-3) before and after PCI (total possible grade, 0-12). Failed perfusion was defined as an APS of 0 to 3, partial perfusion was defined as an APS of 4 to 9, and full perfusion was defined as an APS of 10 to 12. The APS was evaluated in patients from the Double-blind, Placebo-contolled, Multicenter Angiographic Trial of Rhumab CD18 in Acute Myocardial Infarction (LIMIT-AMI; n = 394) and Enoxaparin as Adjunctive Antithrombin Therapy for ST-Elevation Myocardial Infarction-Thrombolysis In Myocardial Infarction (ENTIRE-TIMI) 23 trials (n = 483), and infarct size (120-216 hours after AMI SPECT Technetium-99m Sestamibi data) was assessed in the LIMIT-AMI trial. RESULTS: The APS was associated with the incidence of death or myocardial infarction (failed, 16.7% [n = 18]; partial, 2.5% [n = 155]; full, 2.4% [n = 82]; P =.039 for trend) and larger SPECT infarct sizes (failed, median 39% [n = 10]; partial, 12% [n = 79]; and full, 8% [n = 35]; P =.002). No patient with full APS died, whereas the mortality rate was 11.1% in patients with a failed APS (P =.03). CONCLUSIONS: The APS combines grades of epicardial and tissue level perfusion before and after PCI or at the end of diagnostic cardiac catheterization to arrive at a single angiographic variable that is associated with infarct size and the rates of 30-day death or MI. Partial or full angiographic perfusion scores are associated with a halving of infarct size, and no patients with full angiographic perfusion died.
Authors: Giampaolo Niccoli; Andrea Celestini; Camilla Calvieri; Nicola Cosentino; Elena Falcioni; Roberto Carnevale; Cristina Nocella; Francesco Fracassi; Marco Roberto; Roberta P Antonazzo; Pasquale Pignatelli; Filippo Crea; Francesco Violi Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09-05
Authors: Giampaolo Niccoli; Francesco Fracassi; Nicola Cosentino; Elena Falcioni; Marco Roberto; Giuseppe De Luca; Antonio Maria Leone; Francesco Burzotta; Italo Porto; Carlo Trani; Anna Severino; Filippo Crea Journal: J Cardiovasc Transl Res Date: 2013-09-06 Impact factor: 4.132
Authors: Tomasz Rakowski; Jacek Legutko; Pawel Kleczynski; Agata Brzozowska-Czarnek; Artur Dziewierz; Zbigniew Siudak; Waldemar Mielecki; Andrzej Urbanik; Jacek S Dubiel; Dariusz Dudek Journal: J Thromb Thrombolysis Date: 2010-11 Impact factor: 2.300
Authors: Terje K Steigen; Cheryl Claudio; David Abbott; Michael Schulzer; Jeff Burton; Wayne Tymchak; Christopher E Buller; G B John Mancini Journal: Int J Cardiovasc Imaging Date: 2007-12-12 Impact factor: 2.357
Authors: JoEllyn M Abraham; C Michael Gibson; Gonzalo Pena; Ricardo Sanz; Amjad AlMahameed; Sabina A Murphy; Jesús Blanco; Juan Alonso-Briales; Juan Lopez-Mesa; Federico Gimeno; Pedro L Sánchez; Francisco Fernández-Avilés Journal: J Thromb Thrombolysis Date: 2008-03-11 Impact factor: 2.300
Authors: Yuri B Pride; Jacqueline L Buros; Erin Lord; Matthew C Southard; Caitlin J Harrigan; Lauren N Ciaglo; Marc S Sabatine; Christopher P Cannon; C Michael Gibson Journal: J Thromb Thrombolysis Date: 2007-07-12 Impact factor: 2.300