Gibson et al described the grades used to describe myocardial perfusion during angiography in the Thrombolysis in Myocardial Infarction (TIMI) study.
NOTE: This is similar to that described by van’t Hof et al in 07.33.05, above. The current system differs in that the duration of the blush is evaluated rather than the brightness or density. Also this study used thrombolysis vs PTCA in van't Hof et al.
Functional
Angiographic Appearance
TMP Grade
dye fails to enter the microvasculature with lack of tissue-level perfusion
no or minimal ground-glass appearance ("blush") or opacification of myocardium in the distribution of the implicated artery
0
dye slowly enters but fails to exit from the microvasculature
ground-glass appearance or opacification fails to clear and is present at the next injection 30 seconds later
1
dye shows delayed entrance and exit from the microvasculature
ground glass or opacification is strongly persistent at the end of the washout phase with no or minimal decrease in intensity during washout phase; changes clear by the next inject
2
dye enters and exits normally from the microvasculature
ground glass or opacification clears normally and is similar to findings in an uninvolved artery; there is a moderate to marked decrease in intensity during washout phase; includes blush that is mild in the washout phase and that fades minimally
3
where:
• The washout phase consisted of 3 cardiac cycles.
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