Felix Zijlstra, MD, PhD, University Medical Center Groningen, the Netherlands, was the study's senior investigator. For the study, he and his colleagues recruited 1,071 patients with STEMI, randomly assigning 535 to PCI supported by the Export aspiration catheter and 536 to PCI using conventional techniques.
To assess the quality of myocardial perfusion, the researchers documented myocardial blush grade. A myocardial blush grade of 0 or 1 indicates that little or no x-ray dye has reached from the surface artery into the heart muscle, a sign that the microcirculation is blocked. A myocardial blush grade of 3 indicates that x-ray dye has reached deep into the heart muscle, a sign of good blood flow through the microcirculation. A myocardial blush grade of 2 falls in between. Analysis of the elevated ST-segment on the electrocardiogram -- specifically, its return to a normal baseline -- was also used to gauge the quality of blood flow to the heart muscle.
During angiography, researchers observed a blush grade of 0 or 1 in 17 percent of patients treated with the aid of the aspiration catheter and in 26 percent of patients treated with conventional PCI (p less than 0.001). At 30 days, clinical outcomes were strongly related to the degree of myocardial reperfusion. The rate of death in patients with a myocardial blush grade of 0/1, 2 and 3 was 5.2 percent, 2.9 percent and 1.0 percent, respectively (p equals 0.003). The combined rates of repeat heart attack, repeat procedure in the target artery and death in patients with a myocardial blush grade of 0/1, 2 and 3 were 14.1 percent, 8.8 percent and 4.2 percent, respectively (p less than 0.001).
At one-year follow-up, mortality was significantl
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