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  • Title: Comparison of the angiographic myocardial blush grade with delayed-enhanced cardiac magnetic resonance for the assessment of microvascular obstruction in acute myocardial infarctions.
    Author: Vicente J, Mewton N, Croisille P, Staat P, Bonnefoy-Cudraz E, Ovize M, Revel D.
    Journal: Catheter Cardiovasc Interv; 2009 Dec 01; 74(7):1000-7. PubMed ID: 19626683.
    Abstract:
    BACKGROUND: Both myocardial blush grade (MBG) and cardiac magnetic resonance (CMR) are imaging tools that can assess myocardial reperfusion after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). OBJECTIVES: We studied the relation between MBG and gadolinium-enhanced CMR for the assessment of microvascular obstruction (MVO) in patients with acute ST-elevated myocardial infarction (STEMI) treated by primary PCI. MATERIAL AND METHODS: MBG was assessed in 39 patients with initial TIMI 0 STEMI successfully treated by PCI, resulting in TIMI 3 flow grade and complete ST-segment resolution. These MBG values were related to MVO determined by CMR, performed between 2 and 7 days after PCI. Left ventricular (LV) volumes were determined at baseline and at 6-month follow-up. RESULTS: No statistical relation was found between MBG and MVO extent at CMR (P = 0.63). Regarding MBG 0 and 1 as a sign of MVO, the sensitivity and specificity of these scores were 53.8 and 75%, respectively. In this study, CMR determined MVO was the only significant LV remodeling predicting factor (beta = 31.8; P = 0.002), whatever the MBG status was. CONCLUSION: MBG underestimates MVO after an optimal revascularization in AMI compared with CMR. This study suggests the superior accuracy of delayed-enhanced magnetic resonance over MBG for the assessment of myocardial reperfusion injury that is needed in clinical trials, where the principal endpoint is the reduction of infarct size and MVO.
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