Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction

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Abstract
Aims ST-segment recovery (ΣSTR) and myocardial blush (MB) evaluate different elements of microcirculatory integrity after reperfusion therapy in acute myocardial infarction (AMI). We sought to determine whether the combination of ΣSTR and MB after primary percutaneous coronary intervention (PCI) in AMI has greater prognostic utility than either measure alone. Methods and results The 30 days and 1 year clinical outcomes of 456 patients were assessed as a function of ΣSTR and MB after primary PCI from the CADILLAC trial. ΣSTR and MB were concordant (≥70% ΣSTR and MB grade 2/3 or P=0.05 and 0.01, respectively), whereas MB was no longer predictive (P=0.38 and 0.72, respectively). Conclusion ΣSTR and MB are not infrequently discordant after primary PCI. By univariate analysis, both measures of reperfusion success strongly correlate with survival and assessment of both yields incremental prognostic information beyond either measure alone. By multivariable analysis, however, ΣSTR is the stronger prognostic variable.

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