Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty

Abstract

Despite optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim the current study was to evaluate the impact of preprocedural TIMI flow on myocardial scintigraphic infarct size among STEMI undergoing primary angioplasty. Our population is represented by 793 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Poor preprocedural TIMI flow (TIMI 0-1) was observed in 645 patients (81.3%). Poor preprocedural TIMI flow was associated with more hypercholesterolemia (p = 0.012), and a trend in lower prevalence of diabetes (p = 0.081). Preprocedural TIMI flow significantly affected scintigraphic and enzymatic infarct size. Similar findings were observed in the analysis restricted to patients with postprocedural TIMI 3 flow. The impact of preprocedural TIMI flow on scintigraphic infarct size was confirmed when the analysis was performed according to the percentage of patients above the median (p < 0.001) and after adjustment for baseline confounding factors (Hypercholesterolemia and diabetes) [adjusted OR (95% CI) for pre preprocedural TIMI 3 flow = 0.59 (0.46-0.75), p < 0.001]. This study shows that among patients with STEMI undergoing primary angioplasty, poor preprocedural TIMI flow is independently associated with larger infarct size.

Effects of a timely therapy with doxycycline on the left ventricular remodeling according to the pre-procedural TIMI flow grade in patients with ST-elevation acute myocardial infarction

“…In agreement with previous studies [1,3,4] and with the latest results obtained by De Luca et al [2] on a large series of over 790 patients treated by primary PCI, we also observed that pre-procedural TIMI flow grade significantly affected enzymatic final infarct size, even when an optimal TIMI flow grade 3 post-PCI was obtained. This ominous relationship between low baseline TIMI flow grade and infarct size has been attributed to different factors resulting from the longer time of ischemia [8], as well as microembolization [7], blood clots and platelet plugs in the microcirculation [9], and a greater myocardial reperfusion injury [10].…”

“…This difference is nonsignificant. However, it could be explained by a higher prevalence of diabetes [2] in baseline open artery patients, and diabetes per se is a strong factor for increased plasma pro-BNP level after myocardial infarction [41]. However, at the multivariable analysis the anti-remodeling effect of doxycycline is found to be independent also from pro-BNP level.…”

“…ST-elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (PCI), which may imply shorter ischemia time, a smaller infarct size [1][2][3], and better left ventricular (LV) function [1,3,4], and patient outcome [5,6]. Conversely, an occluded IRA (TIMI flow grade B1) before primary PCI, which is observed in almost 2/3 of patients with STEMI [2], is associated with increased LV remodeling despite an optimal epicardial mechanical recanalization (post-PCI TIMI flow grade 3) [4].…”

“…Conversely, an occluded IRA (TIMI flow grade B1) before primary PCI, which is observed in almost 2/3 of patients with STEMI [2], is associated with increased LV remodeling despite an optimal epicardial mechanical recanalization (post-PCI TIMI flow grade 3) [4]. This ominous relationship between low baseline TIMI flow grade and LV remodeling has been attributed to different factors [7][8][9] including a greater ischemia/reperfusion injury [10].…”

Association Between Preinfarction Angina and Angiographic Findings in Non–ST‐Segment Elevation Myocardial Infarction

“…However, other confounding factors potentially affect infarct size. In fact, various angiographic factors, including preprocedural coronary blood flow, thrombus burden, and collateral circulation to the infarct‐related artery (IRA), have been reported to affect the infarct size in STEMI patients. Interestingly, STEMI patients with preinfarction angina were reported to have favorable angiographic findings compared with those without preinfarction angina, which included a patent IRA, lower thrombus burden, and presence of collateral circulation …”