1. Relationship of Ultrasound Plaque Characteristics to TMPG Following Intracoronary Stenting ↓ TMPG Post PCINo Δ or ↑ TMPGp-value Pre-PCI Plaque Area12.4 ± 6.39.9 ± 4.10.047 Conclusion: Soft plaque and presence of lipid core found by IVUS during procedure was associated with impairment of myocardial perfusion even after successful intervention. Conclusion: Soft plaque and presence of lipid core found by IVUS during procedure was associated with impairment of myocardial perfusion even after successful intervention. Pre-Procedure Soft Plaque p=0.049 Pre-Procedure Soft Plaque p=0.049 Lipid Core p=0.002 Lipid Core p=0.002 ↓ TMPG No Δ or ↑ TMPG No Δ or ↑ TMPG No Δ or ↑ TMPG No Δ or ↑ TMPG N=15 N=117 Zheng et al, ACC 2004

2. Emboli Protection Improves Thrombolysis in Myocardial Infarction Perfusion Score in Saphenous Vein Graft Intervention Conclusion: Embolic protection as part of SVG-PCI improves TMP score when compared to unprotected SVG-PCI. This finding was associated with a decrease in post-procedural MACE. Unprotected SVG-PCI Protected SVG-PCI p-value MACE8.1%4.2%0.04 CK (with TMP < 3) 177 U/L133 U/L0.07 CK-MB (with TMP < 3) 21 ng/mL6 ng/mL0.07 305 patients had a SVG-PCI suitable for EPD; 247 (81%) had an angiogram appropriate for TMP evaluation. Of those, 40 (20%) had an EPD deployed Exaire et al, ACC 2004

3. Evolution of Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade During Primary Coronary Angioplasty in Acute Myocardial Infarction Predicts Long-Term Recovery of Left Ventricular Function Reperfusion Pattern 0/1 to 0/1 (I) n=204 2/3 to 0/1 (II) n=11 0/1 to 2 (III) n=133 2/3 to 2 (IV) n=41 0/1 to 3 (V) n=122 2/3 to 3 (VI) n=74 % pts with complete ST resolution 37.3†36.4†45.9†60.9†52.5†72.9† AUC [U/lxh] 3690 ± 1840 3870 ± 1975 2485 ± 882* 2340 ± 837** 2259 ± 954* 2115 ± 810** EF-24h [%] 42 ± 11† 41 ± 3† 46 ± 9† 45 ± 12† 53 ± 9† 55 ± 8† EF-6m [%] 39 ± 10†,*** 40 ± 3† 45 ± 8† 46 ± 12† 55 ± 9†, †† 59 ± 9†, *** Conclusion: Maintaining a high MPG throughout PCI in AMI or achieving a marked MPG improvement are both related to improved ST resolution, smaller areas under the curve for myonecrosis, and better ejection fractions acutely and at 6 month follow-up. Conclusion: Maintaining a high MPG throughout PCI in AMI or achieving a marked MPG improvement are both related to improved ST resolution, smaller areas under the curve for myonecrosis, and better ejection fractions acutely and at 6 month follow-up. Zalewski et al, ACC 2004 *p<0.01 vs. I, **p<0.01 vs. II, †p<0.001 among I-VI, ††p<0.001 vs. I-IV, ***p<0.01 vs. EF-24h AUC: Area under curve of CK-MB release in the first 48 hours

4. Relationship Between Time to Reperfusion, ST-Segment Resolution, Myocardial Blush Scores and Mortality With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Results from the CADILLAC Trial Conclusion: Early time to reperfusion is associated with a greater likelihood of successful microvascular reperfusion after primary PCI. Brodie et al, ACC 2004 *Defined as >70% The CADILLAC Trial randomized 2,082 pts with AMI to PTCA vs. stenting +/- abciximabThe CADILLAC Trial randomized 2,082 pts with AMI to PTCA vs. stenting +/- abciximab Complete STR was associated with a higher frequency of Grade 2/3 MB (56% vs. 40%, p=0.0007)Complete STR was associated with a higher frequency of Grade 2/3 MB (56% vs. 40%, p=0.0007) 40% of pts with poor STR had good blush scores40% of pts with poor STR had good blush scores 44% of pts with complete STR had poor blush scores44% of pts with complete STR had poor blush scores One year mortality was lowest with optimum microvascular reperfusion (complete STR and Grade 2/3 MB) and highest with poor microvascular reperfusion (0.6% vs. 9.9%, p=0.006)One year mortality was lowest with optimum microvascular reperfusion (complete STR and Grade 2/3 MB) and highest with poor microvascular reperfusion (0.6% vs. 9.9%, p=0.006)

5. Coronary Blood Flow Velocity and Myocardial Perfusion With Balloon Occlusion and Filter-Based Distal Protection Devices in Saphenous Vein Graft Stenting: Early Experience of Two Centers Halkin et al, ACC 2004 Balloon n=57 Filters n=57 p-value Final TFCg (ostium to anastomosis) 14.321.3<0.01 ∆ TFCn (anastomosis to distal landmark) 6.51.5<0.05 Final TFC26.034.00.05 ∆ Final TFC17.46.6<0.05 Measurements done before placement of DPD, and post retrieval. Myocardial blush graded 0-3 using the Zwolle methodology. Difference in TIMI 3 Flow, Baseline Blush 3, Baseline TFCg, ∆TFCg, Baseline TFCn, Final TFCn, and Baseline TFC not statistically significant. Conclusion: Balloon occlusion and aspiration DPD enhance myocardial perfusion compared to filter-based DPDs. N=57 Balloon Filters Final Grade 3 Blush p=0.05 Final Grade 3 Blush p=0.05

6. The Impact of Myocardial Blush Grade on Clinical Outcomes of Patients Treated With Saphenous Vein Grafts and Thrombotic Native Coronary Arteries: Analysis From the X-TRACT Trial Tsuchiya et al, ACC 2004 Conclusion: Absent myocardial perfusion is an important prognostic marker of 6 month complications even among patients who achieve normal epicardial flow (TIMI 3) *P<0.05 vs. MBG 0/1 In the randomized X-TRACT trial, 797 patients underwent PCI to treat diseased SVGs (72.4%) and thrombotic native coronary arteries (27.2%)

7. Conclusion: Improved blush grade in UAP patients undergoing PCI is associated with lower TnI elevation. Improved Myocardial Blush Grade Is Associated With Reduced Troponin I Elevation in Unstable Angina Patients Undergoing Percutaneous Intervention Prasan et al, ACC 2004 MBG 0 n=69 MBG 1 n=58 MBG 2 n=112 MBG 3 n=133 p- value Death5234ns TVR111918 <0.05 372 consecutive UAP treated with PCI were included, none with pre-procedural TnI elevation. TnI was measured 24 hours post procedure. Patients who did not have TnI elevation were ascribed a value of 0.1 ug/L. TVR: Target Vessel Revascularization. N=69 N=58 N=112 N=133

8. Distal Protection Device Was Associated With Better Left Ventricular Function by Improving Microcirculation After Primary Coronary Intervention PercuSurge®C Groupp-value LV Ejection Fraction52% ± 9%45% ± 10%0.01 PercuSurge: Use of PercuSurge® distal protection device C Group: Selected by matching infarct-related artery, pre-angioplasty TIMI flow grade, sex, age, and pain-to-balloon time. There was no significant difference in death, MI, or TIMI 3 Flow. Conclusion: PercuSurge® was associated with a better recovery of myocardial function as well as better microcirculatory function at 30 days after primary angioplasty. Percu- Surge C Group Percu- Surge C Group N=30 N=29 N=30 N=29 Grade 3 Blush p=0.04 Grade 3 Blush p=0.04 Early STR p=0.02 Early STR p=0.02 Rhee et al, ACC 2004

9. Percutaneous Coronary Intervention With Distal Protection Device Preserves Left Ventricular Function in Patients With Acute Anterior Myocardial Infarction Nakamura et al, ACC 2004 Conclusion: PCI with the PercuSurge GuardWire® could not only restore epicardial coronary flow and myocardial perfusion, but also preserve left ventricular function in anterior AMI. cTFC p=0.030 cTFC p=0.030 MBG 3 p=0.029 MBG 3 p=0.029 Peak CK Myocardial Fraction Level p=0.043 Peak CK Myocardial Fraction Level p=0.043 GW Protection Control GW Protection Control GW Protection Control N=42 N=30 N=42 N=30 N=42 N=30

10. Impact of Angioplasty with Distal Protection Device on Myocardial Reperfusion GuardWire Plus™ No Distal Protection p-value cTFC23.7 ± 10.333.7 ± 20.60.04 LVEF*51.2% ± 14.5% 46.7% ± 12.2% 0.02 Severity Score 5.6 ± 6.310.3 ± 7.30.01 Patients within 12 hours after onset of AMI were enrolled and randomly assigned. *Thallium-201 Myocardial Scintigraphy Conclusion: Use of this distal protection device during PCI in patients with AMI was associated with a significant improvement of coronary reperfusion compared with conventional PCI. Guard- Wire No Distal Protection N=34 N=30 N=34 N=30 Grade 3 Blush p=0.02 Grade 3 Blush p=0.02 Early STR p=0.03 Early STR p=0.03 Guard- Wire No Distal Protection Nanasato et al, ACC 2004

11. Angiographically Apparent Thrombus After Fibrinolytic Administration Is Associated With Impaired Epicardial Flow and Myocardial Perfusion in ST Elevation Myocardial Infarction Patients with Open Arteries Conclusion: Angiographically-apparent thrombus after fibrinolytic administration is independently associated with slower epicardial flow and impaired myocardial perfusion, despite a patent epicardial artery. Kirtane, Karmpaliotis et al, ACC 2004 Residual Thrombus No Residual Thrombus p-valueMultivariate† OR p-value TFG 3 n=929 69.3%73.2%0.03N/A CTFC (frames) n=907 34310.0003N/A 0.01 TMPG 2/3 n=929 57.0%68.0%0.0010.71 0.027 †Multivariate regression models incorporating age, time-to-treatment, gender, history of hypercholesterolemia, LAD culprit location, reference segment diameter, percent stenosis of the culprit lesion, lesion length, and TFG 3. Clinical & angiographic data were analyzed from 929 patients with open arteries enrolled in the TIMI 14, 20, 23, and 24 trials in STEMI.

12. Distinct Modes of Cardiovascular Death Associated With Impaired Epicardial and Myocardial Perfusion Following Fibrinolysis for ST Elevation Myoardial Infarction Conclusion: Impairment of epicardial and myocardial perfusion were associated with cardiovascular mortality. Angiographic features differed among causes of death. Wiviott et al, ACC 2004 Cardiac Death (Compared to Survivors) p-value Less likely to have TFG 2-3<0.001 Less likely to have TMPG 2-30.004 Higher CTFC (68 vs. 52)<0.001 3 Vessel CAD0.001 Thrombus0.001 3683 patients from an angiographic database STEMI fibrinolysis trials were analyzed. 180 deaths (4.9%) were observed. Cause of Death % CHF/Shock22% Stroke/ICH18% Dysrhythmia16% Cardiac Rupture 13% MI12% Other Cardiac 7% Hemorrhage3%

13. Objective Evaluation of Tissue Level Perfusion Using Parametric Analysis of Myocardial Blush Kinetics Conclusion: Parametric imaging can be used to objectively analyze tissue level perfusion following percutaneous intervention. This approach may be used to gauge reperfusion strategies in acute coronary syndromes. Kuecherer et al, ACC 2004 Successful Reperfusion Unsuccessful Reperfusion Tmax (cycles from dye injection) 8.6 ± 3.45.6 ± 1.1 Wash-in (grey levels/cycle) 6.0 ± 3.017.2 ± 8.2 Wash-out (gray levels/cycle) 3.8 ± 0.812.6 ± 6.3 Method: Developed and tested a computer assisted procedure to visualize and objectively quantitate both temporal and spatial spread of myocardial blush in 8 normals (mean age 61 years) and in 34 patients (mean age 65 years), defining 4 different parameters for each intensity profile that were displayed as color coded maps: maximal intensity (Gmax), time to maximal intensity (Tmax), maximal upslope (Imax) and maximal downslope (Dmax).

14. Impact of Initial Patency of the Infarct Related Vessel on Outcome in Patients With Acute Myocardial Infarction Treated With Primary Angioplasty Conclusion: Not only TIMI 3 flow, but any increase in initial TIMI flow of the IRV is associated with a better preserved LVEF, smaller enzymatic infarct size and higher MBG. Ernst et al, ACC 2004 TIMI 0 (65%) TIMI 1 (10%) TIMI 2 (12%) TIMI 3 (13%) LDH Q48 All MI1513 ± 1264 1159 ± 1484 1014 ± 956 748 ± 700 LDH Q48 Anterior MI1816 ± 1404 1601 ± 2126 1115 ± 1064 808 ± 831 LVEF All MI43% ± 11% 46% ± 11% 44% ± 11% 48% ± 11% LVEF Anterior MI36% ± 10% 39% ± 13% 41% ± 11% 46% ± 11% Angiographic and clinical data of 1702 consecutive patients with acute MI treated with PA. LDH Q48 : Enzymatic infarct size as determined by serial measurements of lactate dehydrogenase up to 48 hours after onset of symptoms. MBG 2/3:

15. The Role of Collateral Circulation in the Acute Phase of ST-Segment Elevation Myocardial Infarction Treated With Primary Coronary Intervention Conclusion: Presence of angiographically detectable collaterals have a protective effect on enzymatic infarct size and pre- and post-intervention hemodynamic conditions in patients with acute MI treated with early PCI, in particular when Rentrop grade 2/3 is present and in LAD related infarcts. Elsman et al, ACC 2004 Collateral Flow Grade012/3p-value Killip Class ≥2 at Presentation 12%10%4%0.01 Intra Aortic Balloon Pumping Post-PCI 17.2%12.8%4.7%0.0005 LDHQ Q48 (U/l)1947 ± 1553 1893 ± 1549 1221 ± 767 0.001 Between 1994 and 2001, 1074 patients with acute MI treated with early PCI TIMI 0 or 1 flow at first contrast injection and technically adequate angiograms for collateral flow were analyzed. MBG 3: p=0.04

16. Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction and Signs of Heart Failure Conclusion: Patients with ventricular decompensation complicating STEMI have impaired myocardial perfusion, which may accounts for the poor outcome observed in these patients. De Luca et al, ACC 2004 Population represented by a cohort of 1548 consecutive patients with STEMI undergoing primary angioplasty.