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.



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


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


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


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




• The washout phase consisted of 3 cardiac cycles.


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