الفهرس 
Introduction and Aim of the Work
Acute ST elevation myocardial infarction (STEMI)Only 14 pages are availabe for public view
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Abstract
Optimal myocardial perfusion in patients with ST elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (primary PCI) is associated with better clinical outcomes, while suboptimal myocardial perfusion (No-reflow ) associated with increased infarct size, an increased rate of left ventricular (LV) dysfunction, and higher mortality rates. Myocardial blush grade (MBG) has been well validated as an angiographic technique to assess myocardial perfusion in patients with STEMI. MBG correlates with the more accurate methods of evaluating myocardial perfusion (cardiac magnetic resonance imaging) and enables the immediate evaluation of microvascular patency while in the catheterization laboratory (Marlos et al.,2012). Our study was carried out from January 2010 to October 2012, included 100 patients with STEMI, who were subjected to primary PCI. Patients of the study were divided according to final MBG into two groups : • Group 1( optimal reperfusion group): Patients with final MBG= 3 in segments supplied by IRA (n=73) (73%) .
• Group 2(suboptimal reperfusion group): Patients with final MBG ≤2 in segments supplied by IRA (n=27) (27%).
Suboptimal reperfusion occurred in 27% of patient study. And suboptimal reperfusion group compared to optimal reperfusion group had statistically significant fewer patients with history of angina prior to MI 5 (18.5%) vs 44 (60%) , fewer patients with current aspirin therapy 6 (22%) vs 38 (52% ) , increased blood glucose level on admission (240 ± 101 mg/dl vs 171 ±72 mg/dl) , increased TLC on admission (12.1 ± 3.7 vs 10.3 ± 3.3) 103 /mm3 , longer reperfusion time (6.1 ± 2.8 vs 4.3 ± 2.1 h ), more patients with high thrombus burden 12 (44.5 % ) vs 13 (17.8 %), higher predilatation pressure (16.1 ± 2.3 vs 14.7 ± 1.8 ATM), more repeated balloon inflation( > twice) during predilatation 24 (92 % ) vs 46 (70 %), (P <0.05 for all).
Multivariate analysis of the statistically significant variables by univariate analysis revealed that ; Repeated predilatation had odd ratio 8.2, high thrombus burden had odd ratio 5, absence of angina prior to MI had odd ratio 4.38, TLC > 10 (103 /mm3) had odd ratio 3.4, blood glucose > 160 mg/dl had odd ratio 3.0, reperfusion time > 4h had odd ratio 2.68, no current aspirin therapy had odd ratio 2.29, and predilatation pressure > 15 ATM had odd ratio 2.23.
Based on the results of this study it can be concluded that repeated balloon inflation during predilatation, high thrombus burden, no history of angina prior to MI, high TLC, high blood glucose level , longer reperfusion time, no current aspirin therapy and high predilatation pressure were predictors for suboptimal reperfusion.