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Background:Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion. Hypothesis:We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). Methods:In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase ≥ 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion. Results:Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p=0.0001), and ST-segment elevation index at 1 h(r=−0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade ≥ 2 and ST-segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade ≥ 2 showed the better negative likelihood ratio, and ST-segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery. Conclusions:Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG ≥ 2 and ST-segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.

Background: Elderly patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE-ACS in the elderly has not been fully investigated. Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE-ACS stratified according to age and treatment approach. Methods: The feasibility and efficacy of an invasive strategy for NSTE-ACS and the 6-month outcome were assessed in 253 unselected consecutive patients ≥ 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years. Results: Angiography was not performed in 69 patients (86% ≥ 70 years) because of contraindications. In the whole population, the 6-month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1-2.9; p

Background:Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST‐segment reduction are indices of myocardial reperfusion. Hypothesis:We evaluated their predictive value for left ventricular (LV) function recovery by gated single‐photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). Methods:In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase ≥ 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST‐segment elevation index 1 h after PCI were determined to evaluate reperfusion. Results:Twenty‐four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p=0.0001), and ST‐segment elevation index at 1 h(r=−0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST‐segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade ≥ 2 and ST‐segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade ≥ 2 showed the better negative likelihood ratio, and ST‐segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery. Conclusions:Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG ≥ 2 and ST‐segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.

Background: Elderly patients with non‐ST‐elevation acute coronary syndromes (NSTE‐ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE‐ACS in the elderly has not been fully investigated. Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE‐ACS stratified according to age and treatment approach. Methods: The feasibility and efficacy of an invasive strategy for NSTE‐ACS and the 6‐month outcome were assessed in 253 unselected consecutive patients ≥ 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years. Results: Angiography was not performed in 69 patients (86% ≥ 70 years) because of contraindications. In the whole population, the 6‐month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1‐2.9; p