Prognostic utility of myocardial blush grade after PCI in patients with NSTE‐ACS: Analysis from the ACUITY trial

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Abstract
Objective: We evaluated the ability of post‐procedural myocardial blush grade (MBG) to stratify outcomes of patients undergoing percutaneous coronary intervention (PCI) for non‐ST segment elevation acute coronary syndromes (NSTE‐ACS).Background: MBG strongly correlates with survival after reperfusion therapy in patients with ST‐segment elevation myocardial infarction (STEMI).Methods: Of 13,819 NSTE‐ACS patients randomized in the ACUITY trial, 3,115 patients underwent PCI and had MBG analyzed by an independent angiographic core laboratory. We examined net adverse clinical events (NACE; composite ischemia or bleeding), composite ischemia (death, MI or ischemia‐driven revascularization) and non‐CABG major bleeding according to final MBG.Results: At 30 days, patients with MBG‐0/1 had higher rates of NACE (25.1% vs. 13.9%, P = 0.002) and composite ischemia (19.1% vs. 9.4%, P = 0.002) than patients with MBG‐2/3. At 1‐year follow‐up, MBG‐0/1 patients had significantly higher rates of composite ischemia compared to other patients (27.8% vs. 19.8%, P = 0.02). By multivariable analysis, MBG‐0/1 was an independent predictor of 30‐day ischemia‐driven revascularization (OR 5.74 [2.63, 12.54], P < 0.0001) in the total population and among patients with normal post‐PCI epicardial TIMI‐3 flow (OR 6.39 [2.06, 19.78], P = 0.001). However, 1‐year outcomes were similar between patients with and without normal myocardial perfusion.Conclusions: In conclusion, MBG is a predictor of 30‐day revascularization in the overall population and in patients with normal epicardial flow but fails to stratify 1‐year outcomes. Thus, unlike in STEMI patients, the prognostic value of MBG in NSTE‐ACS patients appears to be limited to the short‐term.

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