What question did this study set out to answer?

The research aims to assess the relationship between myocardial blush grades achieved after coronary interventions and patient health outcomes.

January 10, 2026Cureus0 citationsOpen Access

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

MSMuhammad W SaleemHayatabad Medical Complex IUIhsan UllahOllscoil na Gaillimhe – University of Galway MAMaha AmjadKhyber Medical College

Key Points

The research aims to assess the relationship between myocardial blush grades achieved after coronary interventions and patient health outcomes.
Analyzed myocardial blush grades following primary percutaneous coronary intervention.

Structured PICO

Does achieving higher myocardial blush grades (MBG) during primary PCI improve short-term clinical outcomes and LVEF recovery in patients with STEMI?

Population

230 adults (aged 18-80 years) presenting with ST-elevation myocardial infarction (STEMI) within 24 hours of chest pain who underwent primary percutaneous coronary intervention (PCI). Median age 58.0, 73.5% male, based in Khyber Pakhtunkhwa, Pakistan. Excluded: NSTEMI, chronic kidney disease, liver cirrhosis, immunocompromise, chronic pulmonary disease, routine early PCI, and rescue PCI.

Intervention

Primary percutaneous coronary intervention (PCI) achieving normal or moderate myocardial perfusion (Myocardial Blush Grade [MBG] 2 or 3). All patients received loading dose of aspirin 300 mg, clopidogrel 600 mg, and heparin 60 units/kg prior to intervention.

Comparator

Primary percutaneous coronary intervention (PCI) achieving no or minimal myocardial perfusion (Myocardial Blush Grade [MBG] 0 or 1).

Outcome

In-hospital major adverse cardiovascular events (MACE: composite of cardiac death, heart failure, recurrent myocardial infarction, target vessel failure, and target vessel revascularization) and left ventricular ejection fraction (LVEF) at 1-month follow-up.composite

Contrary to previous evidence, achieving higher myocardial blush grades after primary PCI for STEMI was not associated with improved short-term clinical outcomes or LVEF recovery in this cohort, possibly due to prolonged ischemia times.

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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