Angiographic perfusion score: An angiographic variable that integrates both epicardial and tissue level perfusion before and after facilitated percutaneous coronary intervention in acute myocardial infarction

Gibson, C. Michael; Murphy, Sabina A.; Morrow, David A.; Aroesty, Julian M.; Gibbons, Raymond J.; Gourlay, Steven G.; Barron, Hal V.; Giugliano, Robert P.; Antman, Elliott M.; Braunwald, Eugene

doi:10.1016/j.ahj.2003.12.044

Cited by 64 publications

(51 citation statements)

References 21 publications

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“…The Angiographic Perfusion Score (APS) is the sum of the TFG (0 to 3) added to the TMPG (0 to 3) before and after PCI (total possible grade of 0 to 12). 77 Failed perfusion can be defined as an APS of 0 to 3; partial perfusion, 4 to 9; and full perfusion, 10 to 12. 77 Among STEMI patients, the APS is associated with larger SPECT infarct sizes and with the incidence of death or MI, as follows: failed, 16.7%; partial, 2.5%; and full, 2.4% (Pϭ0.039).…”

Section: Integrating the Assessment Of Epicardial And Myocardial Perfmentioning

confidence: 99%

“…77 Failed perfusion can be defined as an APS of 0 to 3; partial perfusion, 4 to 9; and full perfusion, 10 to 12. 77 Among STEMI patients, the APS is associated with larger SPECT infarct sizes and with the incidence of death or MI, as follows: failed, 16.7%; partial, 2.5%; and full, 2.4% (Pϭ0.039). No patient with an APS score of "full" died, whereas mortality was 11.1% among patients with an APS score of "failed" (Pϭ0.03).…”

Section: Integrating the Assessment Of Epicardial And Myocardial Perfmentioning

confidence: 99%

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Coronary and Myocardial Angiography

2004

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A ngiographic assessment of epicardial coronary artery blood flow has played a pivotal role in our understanding of the "time-dependent open artery hypothesis" and in the evaluation of reperfusion strategies over the past 2 decades. [1][2][3][4][5][6][7][8] It has become increasingly apparent, however, that clinical outcomes are not only associated with angiographic flow in the epicardial artery, but also with angiographic flow in the myocardium. 9 -13 To this end, the goal of reperfusion therapies has shifted to include reperfusion downstream at the level of capillary bed, and it might be more appropriate that the hypothesis now be termed "the time dependent open artery and open microvascular hypothesis." The goal of this article is to review angiographic methods used to evaluate myocardial ischemia and infarction and to discuss the insights into the pathophysiology of acute coronary syndromes provided by these angiographic indexes of coronary artery blood flow and myocardial perfusion.

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Section: Integrating the Assessment Of Epicardial And Myocardial Perfmentioning

confidence: 99%

Section: Integrating the Assessment Of Epicardial And Myocardial Perfmentioning

confidence: 99%

Coronary and Myocardial Angiography

2004

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“…A retrospective analysis of the TIMI 23 and LIMIT study illustrates that a normal score is associated with a very low mortality at 30 days post reperfusion. 5 The improvement in early and late mortality in patients with preserved tissue perfusion may be partly mediated by enhanced myocardial salvage, as measured with SPECT or MRI. Normal tissue perfusion (TMG 2-3) measured 2 weeks after thrombolysis or stenting is associated with a significant decrease in infarct size and a higher salvage index as measured by SPECT.…”

Section: Measurement and Predictive Value Of Tissue Perfusion Indicesmentioning

confidence: 99%

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

Forman

Jackson

2007

Clinical Cardiology

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SummaryHigh risk ST segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Importantly, preclinical studies demonstrate that progressive microcirculatory failure (the "no-reflow" phenomenon) contributes significantly to myocardial reperfusion injury. Diagnostic techniques to measure tissue perfusion have validated this concept in humans, and it is now clear that abnormal tissue perfusion occurs frequently in STEMI patients undergoing reperfusion therapy. Moreover, because tissue perfusion correlates poorly with epicardial blood flow (TIMI flow grade), clinical studies show that tissue perfusion is an independent predictor of early and late mortality in STEMI patients and is associated with infarct size, ventricular function, CHF and ventricular arrhythmias. The mechanisms responsible for abnormal tissue perfusion are multifactorial and include both mechanical obstruction and vasoconstrictor humoral factors. Adenosine, an endogenous nucleoside, maintains microcirculatory flow following reperfusion by activating four well-characterized extracellular receptors. Because activation of adenosine receptors attenuates the mechanical and functional mechanisms leading to the "no reflow" phenomenon and activates other cardioprotective pathways as well, it is not surprising that both experimental and clinical studies show striking myocardial salvage with intravenous infusions of adenosine administered in the peri-reperfusion period. For example, a post hoc analysis of the AMISTAD II trial indicates a significant reduction in 1 and 6-month mortality in STEMI patients undergoing reperfusion therapy who are treated with adenosine within 3 hours of symptoms. In conclusion, adenosine's numerous cardioprotective effects, including attenuation of the "no-reflow" phenomenon, support its use in high risk STEMI undergoing reperfusion.

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“…Two cardiologists who were blinded to the patients' clinical situations assessed the postprocedural TIMI flow grade of the IRA. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or TIMI flow grade 3 together with a final MBG of <2, in the same manner as described in previous studies (24,25). For all study participants, only one artery was identified as the IRA.…”

Section: Coronary Angiography (Timi and Myocardial Blush Grade (Mbg) mentioning

confidence: 99%

The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI

Acet¹,

Ertaş²,

Akıl³

et al. 2016

Turk J Med Sci

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Background/aim: The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI).Materials and methods: ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies.Results: A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988). Conclusion:Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.

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Angiographic perfusion score: An angiographic variable that integrates both epicardial and tissue level perfusion before and after facilitated percutaneous coronary intervention in acute myocardial infarction

Cited by 64 publications

References 21 publications

Coronary and Myocardial Angiography

Coronary and Myocardial Angiography

Importance of Tissue Perfusion in ST Segment Elevation Myocardial Infarction Patients Undergoing Reperfusion Strategies: Role of Adenosine

The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI

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