Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Abstract

SummaryThis study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI !2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.(Int Heart J 2017; 58: 674-685)

Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction

“…2) Furthermore, our previous study also reported that MACE was observed in 18% of STEMI patients with slow flow. 7) Because the incidence of short-term MACE is generally lower in NSTEMI than in STEMI, 10,35,36) larger number of study pa-tients and longer follow-up duration would be needed to detect the differences in MACE between the slow flow and the non-slow flow groups in NSTEMI. Study limitation: Since this study was a single-center retrospective observational study, there is a risk of selection bias.…”

“…8,9) In brief, plaque rupture is the dominant cause of STEMI, while plaque erosion and calcified nodule were more frequently observed in the culprit lesion of NSTEMI than that of STEMI. [8][9][10] Therefore, the determinants of slow flow may be different between STEMI and NSTEMI. The purpose of the present study was to verify whether the ratio of stent diameter to vessel diameter can be a modifiable determinant of slow flow in patients with NSTEMI.…”

Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction

“…(Int Heart J 2018; 59: 920-925) Key words: Infarct-related artery, Percutaneous coronary intervention, In-hospital clinical outcomes, Antiplatelet drug P rimary percutaneous coronary intervention (PCI) has been shown to improve the outcome of patients with ST-segment elevation myocardial infarction (STEMI). [1][2][3][4] However, the time delay required for reperfusion of the infarct-related artery (IRA) has been associated with worse outcomes. 5,6) When reperfusion occurs before primary PCI, outcomes are strikingly better with less cardiogenic shock, improved procedural outcomes, smaller infarct size, better preservation of left ventricular function, and reduced mortality.…”

Comparison of Clinical Outcomes between the Ostial Versus Non-Ostial Culprit in Proximal Left Anterior Descending Artery Acute Myocardial Infarction

“…T he development of devices and procedure has improved clinical outcomes of percutaneous coronary intervention (PCI) to the culprit of acute myocardial infarction (AMI). [1][2][3] However, proximal left anterior descending artery (LAD)-AMI has still been associated with high morbidity and mortality because of the broad ischemic area. 4,5) In fact, clinical outcomes were significantly worse in the proximal LAD-AMI as compared with the mid LAD-AMI.…”