The degree of myocardial blush seen after injection of contrast material on angiography following primary angioplasty can be graded using the criteria from Zwolle Myocardial Infarction Study Group.
Appearance on Angiography
no myocardial blush or contrast density
persistent blush or contrast density (“staining”)
minimal myocardial blush or contrast density
moderate myocardial blush or contrast density but less than that normal
normal myocardial blush or contrast density
• Normal blush or contrast density is that seen during angiography of a contralateral or ipsilateral non-infarct-related coronary artery.
• Persistent blush (“staining”) indicates leakage of the contrast material into the extravascular space.
Performance (Table 1, page 2303):
• Interobserver variability was 90%. Reproducibility between 2 observers was 85%.
• Intra-observer variability was 97%.
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