Key result
Low myocardial blush grade linked to ~5-fold higher in-hospital mortality after primary PCI in STEMI.
Why the study?
While microvascular reperfusion determines true myocardial salvage in STEMI, limited data were available from Pakistan regarding the prognostic value of myocardial blush grade in predicting in-hospital outcomes.
Does myocardial blush grade predict reperfusion success and in-hospital adverse outcomes in STEMI patients undergoing primary PCI?
Observational (n=200)
Blinded assessors
No
Does myocardial blush grade predict reperfusion success and in-hospital adverse outcomes in STEMI patients undergoing primary PCI?
Odds Ratio: 5.58 (95% CI 1.09–28.4)
Absolute Event Rate: 8.8% vs 1.7%
p-value: p=0.037
Myocardial blush grade is a strong, independent predictor of reperfusion success and short-term adverse outcomes, including mortality, in STEMI patients undergoing primary PCI.
Low MBG signals higher short-term risk in STEMI PCI patients; leaves open whether MBG-guided strategies improve outcomes.
BACKGROUND: Myocardial blush grade (MBG) is a simple angiographic tool for assessing microvascular perfusion in patients with ST-segment elevation myocardial infarction (STEMI). While restoration of epicardial flow by primary percutaneous coronary intervention (PCI) is critical, microvascular reperfusion determines true myocardial salvage. Limited data are available from Pakistan regarding the prognostic value of MBG in predicting in-hospital outcomes. OBJECTIVE: This study aimed to evaluate the prognostic significance of MBG in STEMI patients undergoing primary PCI, with emphasis on reperfusion success and in-hospital adverse events. METHODS: This prospective observational study was conducted at Lady Reading Hospital Medical Teaching Institution, Peshawar, Pakistan, from January to December 2024. A total of 200 consecutive STEMI patients treated with primary PCI were included. MBG was assessed by two independent interventional cardiologists, and patients were stratified into low MBG (0-1) and high MBG (2-3) groups. Baseline demographics, angiographic findings, and in-hospital outcomes were compared using appropriate statistical tests. Multivariate logistic regression was applied to adjust for confounders. RESULTS: (MI), and had longer door-to-balloon times. Post-PCI Thrombolysis in Myocardial Infarction grade 3 (TIMI 3) flow was achieved in 72.5% of MBG 0-1 versus 96.7% of MBG 2-3 patients (p<0.001). In-hospital mortality was significantly higher in the low MBG group (8.8% vs. 1.7%; OR: 5.58; 95% CI: 1.09-28.4; p=0.037). Low MBG was also associated with recurrent ischemia, acute heart failure, and reduced reperfusion success. On multivariate analysis, MBG 0-1 independently predicted in-hospital adverse outcomes (adjusted OR: 3.42; 95% CI: 1.48-7.91; p=0.004), along with prolonged door-to-balloon time and anterior wall MI. CONCLUSION: MBG is a powerful and independent predictor of reperfusion success and in-hospital outcomes in STEMI patients undergoing primary PCI. Its routine use in clinical practice can aid in early risk stratification, especially in resource-limited settings such as Pakistan. Future multicenter studies with long-term follow-up are warranted to confirm these findings.
No takes yet. Share an insight, caveat, or question.
Khan et al. (2025) conducted an observational in ST-Segment Elevation Myocardial Infarction (STEMI) (n=200). Low Myocardial Blush Grade (MBG 0-1) vs. High Myocardial Blush Grade (MBG 2-3) was evaluated on In-hospital mortality (OR 5.58, 95% CI 1.09-28.4, p=0.037). Low myocardial blush grade (MBG 0-1) was associated with a significantly higher risk of in-hospital mortality compared to high MBG (8.8% vs. 1.7%, OR 5.58) in STEMI patients undergoing primary PCI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: