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Review
. 2022 Jul 21:17:e10.
doi: 10.15420/icr.2022.01. eCollection 2022 Jan.

Prognostic Value of Myocardial Blush Grade in ST-elevation MI: A Systematic Review and Meta-analysis

Patrick Vera Cruz  1   2 , Patricio Palmes  2 , Nadine Bacalangco  2
Affiliations
Review

Prognostic Value of Myocardial Blush Grade in ST-elevation MI: A Systematic Review and Meta-analysis

Patrick Vera Cruz et al. Interv Cardiol. .

Abstract

Background: Ineffective myocardial perfusion despite angiographic success after angioplasty occurs frequently and is associated with an increased risk of mortality. Hence, this study determined whether myocardial perfusion measured by myocardial blush grade (MBG) identifies ST-elevation MI (STEMI) patients at high risk for poor outcomes after successful angioplasty. Methods: The search employed strategies designed for research databases. An article was eligible if it included adults who underwent coronary angioplasty for STEMI, post-angioplasty MBG was assessed, and mortality or major adverse cardiovascular events (MACE) were determined. Risk for bias was assessed using the Quality In Prognosis Studies tool and forest plots in a Mantel-Haenszel fixed effects model were created using RevMan5.4. Results/discussion: Eight observational studies with an overall low risk of bias were included, involving 8,044 patients. MBG 0/1 with no to poor myocardial perfusion had a negative prognostic value for mortality (OR 2.68; 95% CI [2.22-3.23]) and MACE (OR 1.20; 95% CI [1.01-1.41]). Furthermore, MBG 2 with moderate myocardial perfusion and MBG 3 with normal myocardial perfusion were associated with increased survival with a logHR of 0.47 (95% CI [0.43-0.52]) and 0.20 percutaneous coronary intervention (95% CI [0.18-0.23]). These results imply MBG is a useful prognostic marker for STEMI patients. Conclusion: MBG 0/1 after primary angioplasty is a strong negative prognostic marker for long-term all-cause mortality and MACE among STEMI patients, and a post-primary angioplasty MBG of 2 or 3 is a robust prognostic marker for long-term survival.

Keywords: MI; Myocardial blush grade; acute coronary syndrome; angioplasty; myocardial reperfusion; no-reflow; percutaneous coronary intervention.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare. Data Availability: The data that support the findings of this study are available from the corresponding author upon reasonable request. Authors' Contributions: Conceptualisation: PVC, PP, NB; data curation: PVC, PP, NB; formal analysis: PVC, PP, NB; funding acquisition: none; investigation: PVC, PP, NB; methodology: PVC, PP, NB; project administration: PVC, PP, NB; resources: PVC, PP, NB; software: PVC, PP, NB; supervision: PP; validation: PVC, PP, NB; visualisation: PVC, PP; writing – original draft preparation: PVC, NB; writing – review and editing: PVC, PP, NB. Ethics: Since data used in this study are from previously published studies in which informed consent was obtained by primary investigations, no ethics approval was needed for the conduct of this systematic review and meta-analysis. Consent: All patients have given written informed consent. Review Registration and Protocol: This review has not been registered at the time of submission and no protocol was published prior to submission.

Figures

Figure 1:
Figure 1:. PRISMA-P Diagram Showing Study Selection Process
Figure 2:
Figure 2:. Figures and Forest Plot of the Unadjusted ORs Myocardial Blush Grade 0/1 Versus 2/3 for Mortality
Figure 3:
Figure 3:. Figures and Forest Plot of the Adjusted ORs of Myocardial Blush Grade 0/1 Versus 2/3 for Mortality
Figure 4:
Figure 4:. Forest Plot of Myocardial Blush Grade 0/1 Versus 2/3 for Major Adverse Cardiovascular Events
Figure 5:
Figure 5:. Forest Plot of Myocardial Blush Grade 3 Versus 0/1 for Survival
See this image and copyright information in PMC

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