Association of Median Time to Stable ST Resolution Association of Median Time to Stable ST Resolution with TIMI Flow Grades and TIMI Frame Countswith TIMI Flow Grades and TIMI Frame Counts

Association of Median Time to Stable ST Resolution Association of Median Time to Stable ST Resolution with TIMI Flow Grades and TIMI Frame Countswith TIMI Flow Grades and TIMI Frame Counts

0

2

4

6

8

10

12

14

16

0

2

4

6

8

10

12

14

16

N = 77N = 77 N = 42N = 42

P=0.0003P=0.0003

0

2

4

6

8

10

12

14

0

2

4

6

8

10

12

14

46 Min.46 Min.

TIMI Flow GradeTIMI Flow Grade TIMI Frame CountTIMI Frame Count

p=0.001p=0.001

CTFC < 40CTFC < 40 CTFC > 40CTFC > 40TIMI Grade 3TIMI Grade 3 TIMI Grade 0-2TIMI Grade 0-2

N = 72N = 72 N = 47N = 47

109 Min.109 Min. 112 Min.112 Min.

52 Min.52 Min.

Tim

e to

Sta

ble

ST

Re

solu

tio

n (

Min

.)T

ime

to S

tab

le S

T R

eso

luti

on

(M

in.)

Tim

e to

Sta

ble

ST

Re

solu

tio

n (

Min

.)T

ime

to S

tab

le S

T R

eso

luti

on

(M

in.)

Gibson CM, AHJ 2004Gibson CM, AHJ 2004

Relationship of Time to Stable ST Resolution on Relationship of Time to Stable ST Resolution on CContinuous ontinuous ST Segment Monitoring to TMPGST Segment Monitoring to TMPG

Relationship of Time to Stable ST Resolution on Relationship of Time to Stable ST Resolution on CContinuous ontinuous ST Segment Monitoring to TMPGST Segment Monitoring to TMPG

106

80

6453

0

20

40

60

80

100

120

TMPG 0 TMPG 1 TMPG 2 TMPG 3

Min

s t

o S

T r

es

olu

tio

n

106

80

6453

0

20

40

60

80

100

120

TMPG 0 TMPG 1 TMPG 2 TMPG 3

Min

s t

o S

T r

es

olu

tio

n

p = 0.01p = 0.01

n=30 n=19 n=1 n=68

Gibson CM, AHJ 2004Gibson CM, AHJ 2004

Association of TMPG and Continous ST Segment Association of TMPG and Continous ST Segment ResolutionResolution

Association of TMPG and Continous ST Segment Association of TMPG and Continous ST Segment ResolutionResolution

0

500

1000

1500

2000

2500

3000

3500

4000

4500

0

500

1000

1500

2000

2500

3000

3500

4000

4500

P=0.01P=0.01

0

10

20

30

40

50

60

0

10

20

30

40

50

60

27.8%27.8%

p=0.003p=0.003

TMPG 3TMPG 3 TMPG 0-2TMPG 0-2TMPG 3TMPG 3 TMPG 0-2TMPG 0-2

54.4%54.4%

21512151

38173817

Co

mp

lete

ST

Res

olu

tio

n a

t 60

Min

. (%

)C

om

ple

te S

T R

eso

luti

on

at

60 M

in.

(%)

Med

ian

Are

a U

nd

er C

urv

e (

Mic

rovo

lt M

in.)

Med

ian

Are

a U

nd

er C

urv

e (

Mic

rovo

lt M

in.)

Gibson CM, AHJ 2004Gibson CM, AHJ 2004

Early Impaired Myocardial Perfusion is Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct SizeAssociated with Larger SPECT Infarct Size

Early Impaired Myocardial Perfusion is Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct SizeAssociated with Larger SPECT Infarct Size

0

2

4

6

8

10

12

14

16

0

2

4

6

8

10

12

14

16

Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts.

In a multivariate model, both impaired TMPG and incomplete ST resolution were independently associated with larger infarct size

Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts.

In a multivariate model, both impaired TMPG and incomplete ST resolution were independently associated with larger infarct size n=209n=209 n=111n=111

p<0.001p<0.001

0

2

4

6

8

10

12

14

0

2

4

6

8

10

12

14 Median = 13Median = 13

TMPGTMPG ST ResolutionST Resolution

p=0.004p=0.004

Res <70%Res <70% Res >70%Res >70%TMPG 0/1TMPG 0/1 TMPG 2/3TMPG 2/3

n=108n=108 n=113n=113

Median = 7Median = 7

Median = 6Median = 6

Median = 14Median = 14

% S

PE

CT

In

farc

t S

ize

Circulation 2002Circulation 2002

Independent Contribution of Myocardial Blush and ST Independent Contribution of Myocardial Blush and ST Resolution to SurvivalResolution to Survival

Independent Contribution of Myocardial Blush and ST Independent Contribution of Myocardial Blush and ST Resolution to SurvivalResolution to Survival

Hagger et al, J Am Coll Cardiol, 2003Hagger et al, J Am Coll Cardiol, 2003

The myocardial blush and ST resolution following primary PCI are independently related to long term survival in acute myocardial infarction

The myocardial blush and ST resolution following primary PCI are independently related to long term survival in acute myocardial infarction