ABSTRACT
Although technical advances enable normal epicardial coronary artery blood flow to be restored in most patients suffering myocardial infarction, restoration of blood flow is not always followed by improved myocardial perfusion. Recently, therefore, interest in the assessment of myocardial perfusion has grown, and a number of different assessment methods are available. The aim of this article was to provide an evaluation of the additional information that can be obtained from the widely used technique of conventional coronary angiography. We present a review of the data on epicardial coronary artery blood flow (both semiquantitative and quantitative) and on microvascular blood flow that can be obtained using coronary angiography and discuss their prognostic significance.
Subject(s)
Coronary Angiography , Coronary Circulation , Myocardial Infarction/physiopathology , Humans , Microcirculation , Myocardial Infarction/mortality , PrognosisABSTRACT
Aunque los avances tecnológicos permiten restaurar el flujo coronario normal en la arteria epicárdica en la mayoría de los pacientes con infarto de miocardio, no en todos los casos se traduce en la mejoría de la perfusión miocárdica; por ello, el interés clínico en la evaluación de ésta ha crecido recientemente. Son varios los métodos que permiten valorar este parámetro, pero el objetivo de esta revisión es analizar la información adicional que ofrece una técnica ampliamente usada, la simple coronariografía. Se revisan los datos de flujo epicárdico (tanto de forma semicuantitativa como cuantitativa) y microvascular que se pueden obtener con la coronariografía y su implicación pronóstica
Although technical advances enable normal epicardial coronary artery blood flow to be restored in most patients suffering myocardial infarction, restoration of blood flow is not always followed by improved myocardial perfusion. Recently, therefore, interest in the assessment of myocardial perfusion has grown, and a number of different assessment methods are available. The aim of this article was to provide an evaluation of the additional information that can be obtained from the widely used technique of conventional coronary angiography. We present a review of the data on epicardial coronary artery blood flow (both semiquantitative and quantitative) and on microvascular blood flow that can be obtained using coronary angiography and discuss their prognostic significance
Subject(s)
Humans , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Coronary Angiography , Microcirculation , PrognosisABSTRACT
BACKGROUND: The angiographic data of myocardial perfusion obtained following direct angioplasty in acute myocardial infarction (AMI) can be evaluated only by qualitative methods: the myocardial blush grade (MBG) or the TIMI myocardial perfusion grade (TMPG). To minimize the subjective nature of this evaluation, we describe a quantitative index, the "coronary clearance frame count" (CCFC); and have tested it against known indices. METHODS: All patients with AMI treated with direct angioplasty in a single center over 2 years were prospectively analyzed. All films were assessed off-line to determine the traditional indices of TIMI flow grade, TIMI frame count, MBG and TMPG. To define CCFC, we used the first frame in which the contrast is cleared from the ostium of the artery as "frame 0" and that in which contrast begins to wash-in into the same coronary artery distal landmark proposed by TIMI Group, as the "last frame". RESULTS: Of the 147 patients studied, 110 had films that were technically adequate for measuring qualitative and quantitative indices of myocardial perfusion. CCFC showed a good correlation with MBG (p=0.045) and with TMPG (p<0.001). CCFC was strongly related to the presence of TMPG 2 or 3 (p<0.001). A cut-off value of 45 frames has a sensitivity of 75% and specificity of 70% to predict a TMPG 2 or 3. CONCLUSION: Coronary clearance frame count has a good correlation with known indices of reperfusion and has the advantage of being an objective, quantitative index that is efficient even in inexperienced hands. Abbreviated Abstract. The angiographic quality of myocardial perfusion data obtained following direct angioplasty in acute myocardial infarction can only be evaluated by qualitative methods: the myocardial blush grade or the TIMI myocardial perfusion grade. To minimize the subjective nature of these methods, we describe a quantitative index (the "coronary clearance frame count") which we evaluated against the other well-established indices, and have observed it to be efficient even in the hands of inexperienced practitioners.
