Prognostic Value of Myocardial Blush Grade in ST-elevation MI: A Systematic Review and Meta-analysis

Abstract

Background: Ineffective myocardial perfusion despite angiographic success after angioplasty occurs frequently and is associated with an increased risk of mortality. Hence, this study determined whether myocardial perfusion measured by myocardial blush grade (MBG) identifies ST-elevation MI (STEMI) patients at high risk for poor outcomes after successful angioplasty. Methods: The search employed strategies designed for research databases. An article was eligible if it included adults who underwent coronary angioplasty for STEMI, post-angioplasty MBG was assessed, and mortality or major adverse cardiovascular events (MACE) were determined. Risk for bias was assessed using the Quality In Prognosis Studies tool and forest plots in a Mantel-Haenszel fixed effects model were created using RevMan5.4. Results/discussion: Eight observational studies with an overall low risk of bias were included, involving 8,044 patients. MBG 0/1 with no to poor myocardial perfusion had a negative prognostic value for mortality (OR 2.68; 95% CI [2.22–3.23]) and MACE (OR 1.20; 95% CI [1.01–1.41]). Furthermore, MBG 2 with moderate myocardial perfusion and MBG 3 with normal myocardial perfusion were associated with increased survival with a logHR of 0.47 (95% CI [0.43–0.52]) and 0.20 percutaneous coronary intervention (95% CI [0.18–0.23]). These results imply MBG is a useful prognostic marker for STEMI patients. Conclusion: MBG 0/1 after primary angioplasty is a strong negative prognostic marker for long-term all-cause mortality and MACE among STEMI patients, and a post-primary angioplasty MBG of 2 or 3 is a robust prognostic marker for long-term survival.

Relação entre a Relação Fibrinogênio/Albumina e a Perfusão Microvascular em Pacientes Submetidos à Intervenção Coronária Percutânea Primária para Infarto do Miocárdio com Elevação do Segmento ST: Um Estudo Prospectivo

“…13 Uma metanálise recente de 8.044 pacientes mostrou que MBG 0/1 após angioplastia primária estava associada à mortalidade por todas as causas. 22 No presente estudo, determinamos que o aumento do FAR foi um importante fator preditor para MBG 0/1. O aumento do efeito trombogênico do fibrinogênio isolado e o baixo nível de albumina aumentam a agregação plaquetária, levando a distúrbios de perfusão no nível do tecido.…”

Impact of antiplatelet therapy on microvascular thrombosis during ST-elevation myocardial infarction

“…Much to the disappointment of clinicians, it was clear at an early stage of the development of emergency PCI, that despite apparent restoration of vessel patency, the restoration of myocardial blood flow was often poor. Only one-third of patients were found to have evidence of good myocardial blood flow as judged by ST segment resolution and myocardial blush ( Cruz et al, 2022 ). It is thought that this is a result of coronary microvascular obstruction due to distal embolisation of thrombus as well as myocardial oedema.…”