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.
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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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