Myocardial Blush Grades Achieved After Primary Percutaneous Coronary Intervention and Their Relation to Patient Outcomes

TL;DR

This study in Pakistan found that higher myocardial blush grades after heart procedures did not significantly affect patient outcomes or heart function improvement.

Contribution

The study provides new insights into the limited predictive value of MBG in a specific regional STEMI population.

Findings

MBG 0/1 was observed in 33.04% of patients, while MBG 2 and 3 were each seen in 33.47%.

No statistically significant differences in MACE or LVEF were found between MBG groups.

Higher ischemia times and comorbidities may explain the lack of association between MBG and outcomes.

Abstract

Objectives: This study aimed to assess myocardial blush grades (MBG) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in Pakistan and Khyber Pakhtunkhwa. (KPK) Higher MBG has been linked to better clinical outcomes and left ventricular ejection fraction (LVEF) improvement after PCI.

Methods: A single-center observational study was conducted at a tertiary care cardiac center in Pakistan. All STEMI patients presenting to the accident and emergency department (A&E) who met the inclusion criteria were recruited. MBG grades were documented by experienced cardiologists. Clinical outcomes, including major adverse cardiovascular events (MACE) and in-hospital complications, were documented. LVEF was estimated during index hospitalization and at one-month follow-up.

Results: A total of 230 patients were recruited. The median age was 58 (interquartile range [IQR] 50.3-67), 169 (73.5%) were males, 80 (34.8%) had diabetes, 137 (59.6%) had hypertension, and 30 (13%) were current smokers. MBG 0/1 was seen in 76 (33.04%) patients, and MBG 2 and 3 in 77 (33.47%) patients each. MACE occurred in 20 (8.7%) patients, and in-hospital complications occurred in 38 (16.52%) patients. Mean LVEF on arrival and after one month was 44.41±9.03 and 45.7±9.23, respectively. Stratified analysis failed to reveal any statistically significant differences between MACE and LVEF among the groups.

Discussion: Despite high MBG grades in over two-thirds of patients, no significant association was found between MBG and clinical outcomes or LVEF improvement. This may be due to higher ischemia times and comorbidities in our population.

Conclusion: MBG, previously considered a predictor of clinical outcomes and LVEF improvement, is not the sole factor. Other variables play a significant role, and patient risk factors should be considered individually.

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