Penilaian Reperfusi Myocardial Perfusion Contraction Grade (MPCG) dan Myocardial Blush Grade (MBG) Pasca Intervensi Koroner Perkutan Primer (IKPP) pada Penderita Infark Miokard Akut- Elevast ST Segmen

Abstract

Backgrounds : Assesment of myocardial reperfusion after primary Percutaneous Coronary lntervention (pPCI) for patients acute myocardial infarction is not only restoration of macrovascular epicardial coronary artery (TlMl Flow grade), but also could assess indirectly blood flow at microvascular level or microcirculation of myocardium (MBG). TlMl Flow grade 3 was overestimated as prognostic factor cilinical outcomes and contrast density (opacity) factor to determine the MBG grading is infl uenced by subjective interpreter.

Aims : This study aimed to gain a new tool, we called it MPCG scores to asses myocardial reperfusion after pPCl in patients with STEMI. lt was hoped that MPCG has similarity or associated with MBG and has a better prognostic value to predict Major Adverse Cardiovascular Events (MACE) than MBG. Methods : This was an ambispective or mix cohort study. Colleting samples began from 14 september 2004 - 13 september 2012, 121 patients fulfilled the criteria for entry study. Duration of follow up patients within 6 months - 8 years. Both MPCG and MBG grade were evaluated on angiogram afier pPCl procedure by two independent lntervention Cardiologists who were blinded to all data apart from coronary angiogram. Results : MPCG has similarity or moderate association ( reasonable relationship) with MBG ( r = 0,514, p = 0,000). Total MACE during hospitalization in intensive care and ward unit showed that the grade of MPCG was less than the grades of MBG. Multivariate analysis showed that the MPCG grade was only an independent variable prediclor of total MACE compared with those of MBG grade, TlMl Flow grade, ST-segment elevation resolution and other clinical variables. Gonclusions : MPCG has similarity or moderate association with MBG and has better prognostic value in free total MACE after pPCl

Latar belakang : Penilaian reperfusi miokard pasca lKPp pada penderita

infark miokard akut tidak hanya restorasi aliran darah koroner epikardial- makrovaskular (TlMl flow), tapi juga dapat menilai aliran sampai ke level

mikrosirkulasi-mikrovaskular (MBG). Sebagai faktor prognostik, TlMl flow grade 3 'over estimated terhadap bebas kejadian klinis kardiovaskular mayor dan faktor densitas kontras yang dipakai untuk penentuan grade pada MBG sangat dipengaruhi oleh faktor subyektivitas interpreternya. Tujuan : Penelitian ini bertujuan mendapatkan metode baru yaitu MPCG, untuk menilai reperfusi miokard pascalKPp pada penderita IMAEST. Diharapkan MPCG mempunyai kesamaan atau asosiasi dengan MBG, tetapi mempunyai nilai prognostik yang lebih baik terhadap kejadian klinis kardiovaskular mayor (major adverse cardiovascular events-MACE) pascalKPp. Metode : Desain penelitian kohort ambispektif atau miks (retrospektif dan prospektif), pengumpulan sampel dimulai 14 September 2004 13 September 2012, berlangsung 8 tahun. Lama waktu pengamatan berlangsung 6 bulan sampai 8 tahun, dengan jumlah penderita 121 orang. Penilaian skor MPCG dan MBG grade oleh 2 interpreter lntervension Cardiologist yang independen dan tersamar dari hasil rekaman angiografi. Hasil : MPCG mempunyai kesamaan atau asosiasi moderat (reasonable'1 dengan MBG ( r= 0,514 , p = 0,000). MPCG grade mempunyai kejadian klinis kardiovaskular mayor total yang lebih kecil selama perawatan diruang rawat intensif (lCU) dan bangsal (ward) dibandingkan MBG grade.Hasil uji multivariat hanya MBG grade sebagai faktor independen terhadap kejadian klinis kardiovaskular mayor total dibandingkan MBG, TlMl, resolusi elevasi ST segmen dan variabel klinis lainnya. Kesimpulan : MPCG mempunyai kesamaan (asosiasi) dengan MBG dan memiliki nilai prognostik yang lebih baik terhadap bebas kejadian klinis kardiovaskular mayor total pascalKPp