Myocardial blush grade can predict the early ventricular arrhythmias after acute coronary syndrome.

Objective

Ventricular arrhythmias can occur in 2–20% of acute myocardial infarctions (MIs) and associated with hemodynamic disorientation and increased in-hospital mortality.1, 2, 3 However, it remains unclear that the relation between myocardial reperfusion with successful revascularization and ventricular arrhythmias (VAs). The objective of our study was to identify the relationship between myocardial blush grade and VAs.

Methods

We found 107 patients with VA and 107 patients without VA after MI, retrospectively. Patients with VAs (VA occurred in 72 h after myocardial infarction) were named Group-1 and patients without VAs were named Group-2. All patients had TIMI grade 3 myocardial blood flow after PCI. Bare metal stents were used in PCI procedures for all patients. MBG was determined off-line by a blinded two invasive cardiologist on the final angiogram after percutaneous intervention. After the PCI procedures, all patients treated with medical agents, included asetylsalicylic acid, clopidogrel, metoprolol, angiotensine converting enzyme inhibitors and statins, according the guidelines. Sustained ventricular tachycardia, nonsustained ventricular tachycardia and ventricular fibrillation were included in Group 1. All patients undergone echocardiographic evaluation and no structural heart disease was reported in study patients data. Mortality or cardiogenic shock did not occur while hospitalization.

Results

We included 214 patients who had undergone primary percutaneous coronary intervention after myocardial infarction with ST segment elevation. All of groups included 107 patients. The mean age of patients without VAs was 61.40 ± 8.66 years and 65.4% of these patients were men. The mean age of patients with VAs was 63.07 ± 7.95 years and 74.8% of these patients were men. There were no significant differences regarding age, gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, and troponin levels between the groups. Left ventricular ejection fraction was found more depressed in Group-2 (p < 0.001). When we compared Group-1 and Group-2, we found that lower MBG scores had statistically significant relation with ventricular arrhythmias. Patients with ventricular arrhythmias had lower MBG values. With univariate regression analyses, lower MBG values and lower left ventricle ejection fraction associated with ventricular arrhythmias and also ventricular fibrillation. Age, gender, hypertension, diabetes mellitus, hyperlipidemia, smoking and troponin values had no effect on univariate regression analyses.

Conclusion

Our study showed the association between low MBG values and ventricular arrhythmias, especially in patients with ventricular fibrillation. Myocardial blush analysis gives level of microvascular perfusion. The most common cause of ventricular fibrillation is acute coronary ischemia. In our study, lower MBG values are associated with ventricular arrhythmias in patients with STEMI. According to this result, we can say that patients with lower MBG values should stay longer than patients with higher MBG values at coronary care unit to avoid missing ventricular arrhythmias, because ventricular arrhythmias may be associated with hemodynamic disorientation and mortality.