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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Rajendra H. Mehta, MD, MS, FACC^*, Kishore J. Harjai, MD, FACC, David Cox, MD, FACC, Gregg W. Stone, MD, FACC, Bruce Brodie, MD, FACC^||, Judy Boura, MS, FACC, William O'Neill, MD, Cindy L. Grines, MD, FACC^,* Primary Angioplasty in Myocardial Infarction (PAMI) Investigators

^* University of Michigan, Ann Arbor, Michigan, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
Mid Carolina Cardiology, Charlotte, North Carolina, USA
Lenox Hill Hospital, New York, New York, USA
^|| LeBauer Health Care, Greensboro, North Carolina, USA

Manuscript received June 5, 2003; revised manuscript received July 2, 2003, accepted July 7, 2003.

^* Reprint requests and correspondence: Dr. Cindy L. Grines, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA.
cgrines{at}beaumont.edu

OBJECTIVES: The purpose of this study was to determine the clinical and angiographic correlates and outcomes of patients with suboptimal coronary flow after primary percutaneous coronary interventions (PCI).

BACKGROUND: The clinical and angiographic correlates and outcomes of Thrombolysis in Myocardial Infarction (TIMI) 2 flow in patients treated with primary PCI are not known.

METHODS: We evaluated 3,362 patients with ST elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction trials, who underwent primary PCI.

RESULTS: Post-procedural final TIMI 2 flow occurred in 232 (6.9%) patients. Multivariate analysis identified age 70 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1 to 2.2), diabetes (OR 1.9; 95% CI, 1.3 to 2.7), symptom onset to emergency room presentation (OR 1.1; 95% CI, 1.1 to 1.2); initial TIMI 1 flow (OR 3.2; 95% CI, 1.9 to 5.5), and left ventricular ejection fraction <50% (OR 1.7; 95% CI, 1.2 to 2.4) as independent correlates of final TIMI 2 flow. In-hospital (composite of reinfarction, ischemic target vessel revascularization, or death, as well as these events individually) and one-year (reinfarction and/or death) events occurred more frequently in patients with TIMI 2 flow. The Cox proportional hazards model identified TIMI 2 flow to be independently associated with one-year mortality (hazard ratio 3.8, 95% CI, 2.5 to 5.7).

CONCLUSIONS: Final TIMI 2 flow, although uncommon after primary PCI, was strongly associated with hospital and one-year adverse events. The clustering of final TIMI 2 flow in high-risk groups may partially explain the poor prognosis of these patients. Awareness of these risk factors may be useful to clinicians to triage and treat patients undergoing primary PCI.

Abbreviations and Acronyms   CI = confidence interval   LVEF = left ventricular ejection fraction   MACE = major adverse cardiovascular events   OR = odds ratio   PAMI = Primary Angioplasty in Myocardial Infarction   PCI = percutaneous coronary intervention   STEMI = ST elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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