Background Myocardial brush grade (MBG) is used to assess the effectiveness of myocardial reperfusion and impaired MBG is known to be an independent predictor of long term mortality. Early risk stratification to obtain MBG 3 after primary percutaneous coronary intervention (PCI) may benefit in patients with acute myocardial infarction (AMI). The aim of this study is to evaluate the clinical and angiographic procedural predictors which had impact on the MBG 3 in patients with primary PCI.Method A total of 175 consecutive patients (pts) undergoing PCI for AMI were enrolled from May 2004 to June 2010 (116 males, mean age of 61.54 ± 12.00 years). After PCI, patients were divided into two groups (MBG 3 group: n=111, non-MBG 3 group: n =64). Baseline clinical and angiographic characteristics were compared between two groups, and clinical and angiographic procedural predictors of post-procedure MBG 3 were evaluated.Results Baseline clinical and angiographic characteristics showed that incidence of diabetes mellitus (DM, 33.9% vs 66.1%, p=0.024), hypertension (HTN, 57.6% vs 69.4%, p=0.05), smoking (36.6% vs 63.4%, p=0.031) and systolic blood pressure (SBP, 120.62 ± 27.36 132.76 ± 28.32, P=0.039) were higher in non-MBG 3 group. Left ventricular ejection fraction (LVEF, 52.54 ± 10.88 vs 44.40 ± 11.39, p=0.001), the rate of RCA ( 44.9% vs 30.7%, p=0.023) and post TIMI 3 flow (96.5% vs 71.2%, p=0.001) were higher in MBG 3 group. Lesion length (17.74±6.96 vs 21.57±17.80, p=0.02), balloon length (16.50±3.87 vs 18.18 ±3.76, p=0.02) and stent length (18.59 ± 5.35vs 20.07±5.79) were longer in non-MBG3 group. The rate of total occlusion (38.6% vs 60.5%, p=0.001), thrombus (57.6% vs 72.8%, p=0.023), pre-TIMI 0or 1 flow (66.9% vs 84%, p=0.001) were higher in non-MBG 3 group. Multivariate analysis showed that low LVEF (HR = 7.286, p-value <0.001, 95% CI: 2.599-20.423) and total occlusion (HR =2.342, p-value=0.009, 95% CI: 1.239-4.426) were independent predictor of non-MBG 3. Conclusion Lower LVEF and total occlusion were independent predictor of non-MBG 3. As the result, we assumed that the AMI patients with high risk clinical and angiographic characteristics may have lower chance of MBG3 and could consider adjunctive therapy such as aspiration thrombectomy.
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