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CLINICAL STUDIES

Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction

^a Cardiology Department, Green Lane Hospital, Auckland, New Zealand

Manuscript received November 24, 1999; accepted January 13, 2000.

Reprint requests and correspondence: Dr. John French, Cardiology Department, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand
johnf{at}ahsl.co.nz

OBJECTIVES

To evaluate the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) as a predictor of late survival after myocardial infarction.

BACKGROUND

Thrombolysis in Myocardial Infarction flow grades predict late survival after myocardial infarction. The CTFC provides a more reproducible measurement of infarct-related artery blood flow than the TIMI flow grade, and has been linked to 30-day outcomes, but it has not yet been established how the CTFC correlates with late survival.

METHODS

Of 1,001 patients with acute myocardial infarction presenting within 4 h of symptom onset, 882 underwent angiography at approximately three weeks. Infarct artery flow was assessed, blinded to clinical outcomes, according to the CTFC and TIMI flow grade. Late cardiac mortality and survival were determined in 97.5% of patients.

RESULTS

The mean CTFC was 40 ± 29 in 644 patent infarct arteries (median, 34 [interquartile range, 24 to 47]). The CTFC, assessed as a continuous univariate variable, was found to be a predictor of five-year survival, as was the TIMI flow grade (both p < 0.001). On multivariate analysis, factors associated with five-year survival included the ejection fraction or end-systolic volume index (both p < 0.001), exercise duration (p = 0.005), age (p = 0.008), diabetes (p = 0.02) and CTFC (p = 0.02) or TIMI flow (p = 0.02). The same factors, except for the CTFC and TIMI flow grade, were predictors of 10-year survival.

CONCLUSIONS

The CTFC three weeks after myocardial infarction was an independent predictor of five-year survival, but not 10-year survival. Although the CTFC provided additional prognostic information within TIMI flow grades, its superiority was not demonstrated.

Abbreviations and Acronyms   CASS = Coronary Artery Surgery Study   CTFC = corrected TIMI frame count   GISSI = Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico   GUSTO = Global Use of Strategies to Open Occluded Coronary Arteries   HEAP = Heparin in Early Patency   IQR = interquartile range   TIMI = Thrombolysis in Myocardial Infarction

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