A 65-year-old man with anterior STEMI undergoes primary PCI. Post-procedure, the interventional cardiologist reports TIMI-3 flow in the LAD with myocardial blush grade 2 and complete ST-segment resolution at 90 minutes. Which parameter is the strongest predictor of long-term survival?
- A Myocardial blush grade 2
- B TIMI-3 flow ✓
- C Complete ST-segment resolution
- D Residual stenosis less than 30%
Correct answer: B. TIMI-3 flow
Explanation
TIMI-3 flow (normal epicardial flow) is the strongest predictor of survival after primary PCI for STEMI. Myocardial blush grade reflects microvascular perfusion and adds prognostic value but is secondary to TIMI flow. ST-segment resolution is a surrogate marker and useful when TIMI flow data is not available. Residual stenosis affects symptoms but is less predictive of mortality than achieving TIMI-3 flow.
Reference: Braunwald's Heart Disease, 12th ed.
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