TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction

Abstract

BackgroundGrowing evidence suggests that poor coronary blood flow after primary percutaneous coronary intervention (PCI) is associated with unfavorable clinical out-come. We retrospectively evaluated data from our single center “real world patients” database of patients undergoing primary PCI to determine differences in clinical and angiographic patterns in patients with or without restoring thrombolysis in myocardial infarction (TIMI) flow 3.Methods and resultsBetween 2001 and 2006, 500 patients underwent primary PCI for STEMI. In 430 patients, post-interventional TIMI flow 3 could be established. In this group, in-hospital mortality was significant lower (6.4% Vs. 32.9%; P < 0.0001), left ventricular ejection fraction was better (51.3 Vs. 44.2%; P < 0.0001), and prehospital fibrinolytic therapy (6.3% Vs. 14.3%; P = 0.015), cardiogenic shock (10.9% Vs. 24.3%; P = 0.002) and use of intra-aortic balloon pump were all more unlikely (5.8% Vs. 11.4%; P = 0.045) compared to patients with TIMI flow ≤ 2. In patients with post-interventional TIMI flow ≤ 2 the left anterior descending coronary artery (LAD) was significantly more often seen as the target vessel (54.3% Vs. 44.6%; P = 0.039). A regressions analysis showed that predictors leading to such flow patterns are diabetes (P = 0.013), pre-hospital fibrinolytic therapy (P = 0.017), cardiogenic shock (P = 0.002) and a 3-vessel disease (P = 0.003). After 6 months, patients without restored normal TIMI flow had worse New York Heart Association functional class (NYHA), and had to undergo repeat coronary angiography more often.ConclusionPost-interventional TIMI flow ≤ 2 is strongly associated with adverse out-come during hospitalization and after 6 months following hospitalization.

The impact of unsuccessful percutaneous coronary intervention on short‐ and long‐term prognosis in STEMI and NSTEMI

“…A few studies showed that TIMI-3 flow before PCI was an independent determinant of survival in AMI treated by primary PCI [4,5]. The post-procedural TIMI flow grade <3 has also been reported to be a risk factor of an early and late mortality in AMI [9]. Mehta et al showed that unsuccessful PCI, defined by TIMI < 3 after PCI, in STEMI patients with cardiogenic shock was associated with significantly higher in-hospital mortality rates [10].…”

Uric acid: A novel prognostic marker for cardiovascular disease

“…On the other hand, Duran et al showed that high levels of UA affect the coronary collateral vessels (CCV) development negatively in patients with ACS [19]. We know that poor coronary blood flow following primary PCI and undeveloped CCV related closely in prognosis patients with MI [20,21].…”

Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion

“…The clinical practice in PCI procedures focuses on restoration of epicardial blood flow, as patients with optimal blood flow in culprit vessel after PCI for acute myocardial infarction (AMI) have less extensive necrosis and better regional and global contractile function, lower incidence of adverse events and mortality than patients with poor postprocedural blood flow in infarct-related artery 1,2 . The success rate of achieving the postprocedural TIMI 3 flow and related patient characteristics in the present study conform to other studies: patients with postprocedural TIMI <3 flow were older, more commonly women, diabetics, with more frequent initial hemodynamic instability (Table 1) (ref.…”

“…Restoration of epicardial blood flow in the infarctrelated artery (IRA) in patients with myocardial infarction is associated with greater myocardial salvage and increased survival 1,2 . The patency rate of the IRA in STEMI patients treated with fibrinolysis ranges between 60% and 80% and is strongly time-dependent [3][4][5] .…”