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CLINICAL STUDY: ACUTE CORONARY SYNDROME/MYOCARDIAL INFARCTION

Thrombolysis in myocardial infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis

Alban Dibra, MD^*, Julinda Mehilli, MD^*, Josef Dirschinger, MD^*, J.ürgen Pache, MD^*, Jodi Neverve, BS, Markus Schwaiger, MD, Albert Schömig, MD^* and Adnan Kastrati, MD^*,*

^* Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Munich, Germany
Klinik und Poliklinik für Nuklearmedizin rechts der Isar, Technische Universität München, Munich, Germany

Manuscript received July 11, 2002; revised manuscript received November 21, 2002, accepted November 27, 2002.

^* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 Munich, Germany.
kastrati{at}dhm.mhn.de

OBJECTIVES: We sought to assess the relationship between the Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion (TMP) grade and myocardial salvage as well as the usefulness of TMP grade in comparing two different reperfusion strategies.

BACKGROUND: The angiographic index of TMP grade correlates with infarct size and mortality after thrombolysis for acute myocardial infarction (AMI). Its relationship to myocardial salvage and its usefulness in comparing different reperfusion strategies are not known.

METHODS: We analyzed the TMP grade on angiograms obtained at one to two weeks after treatment in 267 patients enrolled in two randomized trials that compared stenting with thrombolysis in AMI. Patients were classified into two groups: 159 patients with TMP grade 2/3 and 108 patients with TMP grade 0/1. Two scintigraphic studies were performed: before and one to two weeks after reperfusion. The salvage index was calculated as the proportion of the area at risk salvaged by reperfusion.

RESULTS: Patients with TMP grade 2/3 had a higher salvage index (0.49 ± 0.42 vs. 0.34 ± 0.49, p = 0.01), a smaller final infarct size (15.4 ± 15.5% vs. 22.1 ± 16.2% of the left ventricle, p = 0.001), and a trend toward lower one-year mortality (3.8% vs. 8.3%, p = 0.11) than patients with TMP grade 0/1. The relationship between TMP and salvage index was independent of the form of reperfusion therapy. The proportion of patients with TMP grade 2/3 was significantly higher after stenting than after thrombolysis (70.9% vs. 48.1%, p = 0.001).

CONCLUSIONS: These findings show that the TMP grade is a useful marker of the degree of myocardial salvage achieved with reperfusion and a sensitive indicator of the efficacy of reperfusion strategies in patients with AMI.

Abbreviations and Acronyms   AMI   acute myocardial infarction   IRA   infarct-related artery   LV   left ventricle, left ventricular   STOPAMI   Stent versus Thrombolysis for Occluded coronary arteries in Patients with Acute Myocardial Infarction trial   TIMI   Thrombolysis In Myocardial Infarction   TMP   TIMI myocardial perfusion

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