TIMI myocardial perfusion grade 1

Associate Editor-In-Chief:

Description
Dye slowly enters, but fails to exit the microvasculature. There is ground glass appearance (“blush”) or opacification of the myocardium in the distribution of the artery that fails to clear from the microvasculature, and dye staining is present on the next injection (approximately 30 seconds between injections).

Dye staining does not include arterial or venular stains. The TMPG should not be given a grade of 1 solely because either of the former are present, but only if myocardial or arteriole stains are present.

There are separate fields on the CRF to note the presence of arterial/venular stains.


 * Intensity Range: 0 – 3


 * Note – If a stain is present, the blush counts can all be assessed. Quantitative blush analysis is always assessed in relation to the myocardium. For example, if the myocardium itself is stained, thus giving the cinerun a TMPG of “1”, then ignore the presence of the stain when assessing both of the following fields:


 * 1. The “Frame When Blush First Appears” should be a number>0 and should be when blush first starts to enter the myocardium, not the blush that is already present because of the stain.


 * 2. The “Total Frames Elapsed in which Blush is Present” should be the first frame in which blush is no longer present (again ignoring the stain) minus the “frame when blush first appears”.

All other counts would be assessed as normal.

Angiographic Findings
Videos shown below are courtesy of C. Michael Gibson MS. MD. and copylefted.

Video 1
The right coronary artery



Video 2
The circumflex artery

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