Angiographic evaluation of myocardial perfusion in patients with syndrome X.

We evaluated tissue level perfusion in patients who had syndrome X using the myocardial blush grade technique. Normal tissue perfusion in all coronary territories was observed in 23 patients (41.8%) who had syndrome X and in 44 control subjects (80%). Total myocardial blush score (sum of the myocardial blush grades of each coronary territory) was significantly lower in patients who had syndrome X than in control subjects (8.2 +/- 0.7 vs 8.7 +/- 0.5, p <0.0001). We have demonstrated for the first time that a substantial number of patients who have syndrome X have impaired tissue level perfusion, and this might be assumed as a surrogate marker of a diseased microvascular network in the catheterization laboratory.