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Other Angiographic Efficacy Endpoint: TIMI Myocardial Perfusion (TMP) Grades

Other Angiographic Efficacy Endpoint: TIMI Myocardial Perfusion (TMP) Grades. TMP Grade 3. TMP Grade 2. TMP Grade 1. TMP Grade 0. Normal ground glass appearance of blush Dye mildly persistent at end of washout. Dye strongly persistent at end of washout Gone by next injection.

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Other Angiographic Efficacy Endpoint: TIMI Myocardial Perfusion (TMP) Grades

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  1. Other Angiographic Efficacy Endpoint: TIMI Myocardial Perfusion (TMP) Grades TMP Grade 3 TMP Grade 2 TMP Grade 1 TMP Grade 0 Normal ground glass appearance of blush Dye mildly persistent at end of washout Dye strongly persistent at end of washout Gone by next injection Stain present Blush persists on next injection No or minimal blush 6.2% 5.1% p = 0.05 Mortality (%) 4.4% 2.0% n = 79 n = 434 n = 46 n = 203 Gibson et al, Circulation 2000

  2. Not All TIMI Grade 3 Flow is Created Equally: Among Patients. With Successful Lysis, There is a 7 Fold Range in Mortality P = 0.007 5.4% 2.9% % Mortality 0.7% N = 278 N = 34 N = 136 Myocardial Perfusion Grade 3 Myocardial Perfusion Grade 2 Myocardial Perfusion Grades 0/1 Gibson CM, et al.Circulation. 2000;101:125-130.

  3. TIMI 10 B: Independent Predictors of 2 Year Mortality Pre-PCI Epicardial and Myocardial Flow Are Independently Associated with 2 Year Mortality • TIMI Grade 3 Flow RR 0.61, p=0.047 • TIMI Myocardial Blush RR 0.50, p = 0.038 In a MV model correcting for : Performance of PCI Age Gender Pulse Anterior MI Gibson et al, Circulation 2002

  4. 900 1440 2790 360 2250 90 Myocardial Perfusion After Primary PCI is Strongest Predictor of Mortality Myocardial Blush Grades 100 3 n=148 2 n=393 95 3 0/1 n=236 90 Cumulative Survival (%) Final Blush Score (patients with final TIMI grade 3 flow) 2 Time (days) 85 van ‘t Hof AWJet al. Circulation 1998; 97:2302-6. Blush 1-Year Mortality 0/1 3 6.8% Relation of Myocardial Perfusion Grade to Mortality 80 2 13.2% P=0.004 0/1 18.3% 75 0 2 4 6 8 10 12 Stone GW, et al. J Am Coll Cardiol. 2002;39:591-597. Independent Angiographic Variables as Risk Factors of Long-Term Mortality in Patients With TIMI Grade 3 flow After Angioplasty Haagar PK, et al. J Am Coll Cardiol. 2003;41:532-538 • 2 of 3 pts have a closed muscle after 10 PCI • Mortality goes up 3 fold Henriques JP, et al. Circulation. 2003;107:2115-2119.

  5. Myocardial Blush and Mortality: CADILLAC Results Costantini, J Am Coll Cardiol 2004;44:305–12

  6. Independent Contribution of Myocardial Blush and ST Resolution to Survival The myocardial blush and ST resolution following primary PCI are independently related to long term survival in acute myocardial infarction Hagger et al, J Am Coll Cardiol, 2003

  7. Further Risk Stratification Provided by the TMPG among Patients with TIMI 3 Flow or TIMI 2/3 flow Martinez-Rios MA, Am J Cardiol 2004;93:280–287.

  8. Combining TIMI Flow and Perfusion Grades Martinez-Rios MA, Am J Cardiol 2004;93:280–287.

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