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The TIMI Myocardial Perfusion Grade (TMPG) System

Download original definitions and examples as well as initial description of association with mortality  Request Download of slides

Example of an open LAD and pale or closed myocardium (TMPG 0) with LV gram that shows anterior wall hypokinesis  Request Download of slides

Association of Abnormal Myocardial Perfusion (TMPG) with Mortality

Many studies have now associated impaired myocardial perfusion with higher mortality, including long term mortality to 8 years of follow-up. These slides summarize these studies.  Request Download of slides

Data Demonstrating Improved Myocardial Perfusion (TMPG) with Glycoprotein IIbIIIa Inhibition 

PROTECT-TIMI 30

Randomized Trial to Evaluate the Relative PROTECTion against Post-PCI Microvascular Dysfunction and Post-PCI Ischemia among Anti-Platelet and Anti-Thrombotic Agents

Trial Design Part 1:  Request Download of slides   (4.1 Mb)

Trial Design & Results Part 2:  Request Download of slides   (2.4 Mb)

Lessons Learned Part 3:  Request Download of slides   (6.3 Mb)

Lessons Learned Part 4:  Request Download of slides   (3.7 Mb)

Request Download of general slides from prior studies

Association of greater GP IIbIIIa receptor occupancy with improved angiographic and electrocardiographic outcomes  Request Download of slides

Association of troponin elevations on admission with abnormal myocardial perfusion (TMPG) on diagnostic cath & association of earlier GP IIbIIIa inhibition with improved myocardial perfusion (TMPG) on arrival to the cath lab. Request Download of slides

The Disconnect Between Hyperemic (Faster than Normal) Flow in the Epicardial Artery and Abnormal Myocardial Perfusion (TMPG)

See an example of faster than normal flow in an LAD with a stain of the myocardium. Note the deceleration of dye in the distal territory of injury  Request Download of slides

Animal studies demonstrate how micro-embolization is associated with a decline in LV function while coronary flow actually speeds up due to endogenous adenosine release.  Request Download of slides

Association of Abnormal Myocardial Perfusion (TMPG) with Impaired LV Function

Studies have shown that impaired myocardial perfusion is associated with larger infarct sizes on SPECT imaging as well as poorer recovery of LV function over the next 6 months (poorer myocardial salvage)  Request Download of slides

Blush and hemodynamic abnormalities  Request Download of slides

Time is Muscle: Association of Abnormal Myocardial Perfusion (TMPG) with Longer Duration of Symptoms in STEMI and Longer Door to Balloon Times  Request Download of slides

Vasospasm as a Cause of Impaired Myocardial Perfusion (TMPG) & Its Treatment  Request Download of slides

Embolization as a Cause of Impaired Myocardial Perfusion (TMPG)

Embolus going down LAD  Request Download of slides

Studies implicating coronary embolization with impaired myocardial perfusion and CK elevations.  Request Download of slides

Autopsy studies of patients with sudden death showing areas of impaired perfusion  Request Download of slides

Autopsy studies where latex is injected into coronary arteries showing the dense capillary network downstream  Request Download of slides

Association of Myonecrosis Following PCI with Abnormal Myocardial Perfusion (TMPG) and Adverse Outcomes Including Mortality  Request Download of slides

MRI Studies and Their Association with Abnormal Myocardial Perfusion (TMPG)

MRI can be performed to image the myocardium. Learn how this imaging modality and the angiogram are concordant in their assessment of abnormal myocardial perfusion Request Download of slides

The Angiographic Perfusion Score: Integrating the TIMI Flow Grades and TIMI Myocardial Perfusion Grades Before and After Facilitated PCI Request Download of slides

Association of Abnormal Myocardial Perfusion (TMPG) with ST segment and EKG changes Request Download of slides

Changes in Abnormal Myocardial Perfusion (TMPG) Over Time & Association with LV Function  Request Download of slides

Myocardial Contrast ECHO and Abnormal Myocardial Perfusion (TMPG) Request Download of slides

What is the most powerful Predictor of Troponin Elevation on Admission in ACS? Myocardial Perfusion (TMPG) on Diagnostic Catheterization Request Download of slides

 

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"Treatment Strategies in Interventional Cardiology A Palm Textbook"

 

Edited by C. Michael Gibson, M.S., M.D.

 

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These slides, written material and other media present data to support the rationale for the use of a variety of pharmacologic agents and devices in both approved and non-approved indications.  Actual prescribing information is by intent minimal or completely lacking. These slides have been prepared for scientific educational purposes, and cannot be considered an inducement to use any drug or device in non-registered indications.The site does not recommend the use of any drug or device in any manner inconsistent with that described in the full prescribing information.