CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
TIMI frame count immediately after primary coronary angioplasty as a predictor of functional recovery in patients with TIMI 3 reperfused acute myocardial infarction
Shinichi Hamada, MD*,
Takashi Nishiue, MD*,
Seishi Nakamura, MD*,
Tetsuro Sugiura, MD ,
Hiroshi Kamihata, MD*,
Hironori Miyoshi, MD*,
Yusuke Imuro, MD* and
Toshiji Iwasaka, MD*
* Cardiovascular Center, Kansai Medical University, Osaka, Japan
Department of Clinical Laboratory Medicine, Kochi Medical School, Kochi, Japan
Manuscript received December 6, 2000;
revised manuscript received April 25, 2001,
accepted May 17, 2001.
Reprint requests and correspondence: Dr. Shinichi Hamada, Cardiovascular Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
shamada{at}remus.dti.ne.jp
OBJECTIVES
The purpose of this study was to evaluate whether higher coronary blood flow, estimated by the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC), is related to better functional and clinical outcome after successful percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
BACKGROUND
Experimental studies have found that functional recovery of the infarcted myocardium was associated with increased blood flow (reactive hyperemia) to the infarcted bed shortly after reperfusion.
METHODS
We measured CTFC immediately after successful (TIMI 3) primary PTCA in 104 consecutive patients with their first AMI. Wall motion score index (WMSI) and the presence of pericardial effusion were assessed by two-dimensional echocardiography before and one month after PTCA.
RESULTS
The patients were divided into two groups according to mean CTFC for corresponding coronary artery of the control group: TIMI 3 slow group (45 patients, 40 > CTFC  23) and TIMI 3 fast group (59 patients, CTFC < 23). There were no significant differences in the baseline characteristics and WMSI before reperfusion between the two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group (1.33 ± 0.52 vs. 0.60 ± 0.34, p < 0.001). Pericardial effusion and intractable heart failure were observed more frequently in the TIMI 3 slow group than in the TIMI 3 fast group (27 vs. 10%; p < 0.05, 36 vs. 17%; p < 0.05). Corrected TIMI frame count, assessed as a continuous variable, had a significant correlation with the change in WMSI (r = 0.60, p < 0.001) after adjusting for age, gender, history of hypertension, history of diabetes, elapsed time to PTCA, collateral grade, presence of antegrade flow before PTCA and number of diseased vessels.
CONCLUSIONS
Lower CTFC of the infarct-related artery immediately after PTCA was associated with greater functional recovery; and hence, CTFC can predict clinical and functional outcome in patients with successful PTCA.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CPK | = creatine phosphokinase | | CTFC | = corrected TIMI frame count | | ECG | = electrocardiogram | | IRA | = infarct-related artery | | LAD | = left anterior descending coronary artery | | LCX | = left circumflex coronary artery | | LV | = left ventricular, left ventricle | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery | | TIMI | = Thrombolysis In Myocardial Infarction |  WMSI | = absolute change in the wall motion score index |
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