Role of Angiographic Perfusion Score in Reperfusion Success and Risk Stratification Following Percutaneous Coronary Intervention in Acute Coronary Syndromes without Thrombolytic Pre-treatment

Identifying the reperfusion success angiographically and predicting the prognosis is important following the Percutaneous Coronary Intervention (PCI). Though the assessment of successful PCI is still done by Thrombolysis in myocardial infarction (TIMI) Flow Grades (TFG), TIMI Myocardial perfusion grade (TMPG) is also a well accepted method of predicting outcomes in acute coronary syndrome (ACS) patients. Angiographic perfusion score (APS) that integrates both epicardial (TFG) and Myocardial tissue level perfusion (TMPG) before and after percutaneous coronary intervention may accurately measure the reperfusion success and predict Major adverse cardiac events (MACE) in ACS without any thrombolytic pre-treatment. This observational study was done in the Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2014 to July 2015. With the appropriate methodological and statistical analysis, the data was drawn from the sample size of 60 eligible patients. APS (0-12) and post-procedure TMPG (0-3) alone were assessed following PCI in all eligible patients and then compared for the reperfusion success and short term (within 30days) clinical outcomes of MACE. Reperfusion success was identified significantly more in APS group versus TMPG alone (STEMI: 69.5% vs. 21.7% (p<0.05); Non STEMI/UA, late perfusion: 81.8% vs. 30.3% (p<0.05) respectively. A significantly lower incidence of MACE was found in the Full as compared to the Failed APS group (2.3% vs. 100%) (p<0.001). But no differences were observed between TMPG 1-3 (12.5%; 3.4% & 6.7%, respectively) (p=NS). Compared to TMPG alone, APS is a better reflector of reperfusion success as well as favorable predictor for short term clinical risk following PCI done during the index hospitalization in ACS.