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J Am Coll Cardiol, 2004; 43:1363-1367, doi:10.1016/j.jacc.2003.11.042
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty

Giuseppe De Luca, MD*, Nicolette Ernst, MD*, Felix Zijlstra, MD, PhD, FACC*, Arnoud W. J. van't Hof, MD, PhD*, Jan C. A. Hoorntje, MD, PhD*, Jan-Henk E. Dambrink, MD, PhD*, A. T. Marcel Gosslink, MD, PhD*, Menko-Jan de Boer, MD, PhD, FACC* and Harry Suryapranata, MD, PhD*,*

* ISALA Klinieken, Hospital De Weezenlanden, Zwolle, the Netherlands

Manuscript received May 27, 2003; revised manuscript received September 20, 2003, accepted November 26, 2003.

* Reprint requests and correspondence: Dr. Harry Suryapranata, ISALA Klinieken, Hospital De Weezenlanden, Groot Wezeland 20, 8011 JW Zwolle, the Netherlands.
h.suryapranata{at}diagram-zwolle.nl

OBJECTIVES: The aim of the study was to evaluate the impact of preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow on one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty.

BACKGROUND: Although there is an excellent outcome conferred by primary angioplasty in patients with STEMI, the prognostic role of early recanalization in these patients has yet to be investigated.

METHODS: Our population is composed of 1,791 patients with acute myocardial infarction treated by primary angioplasty at our institution from 1994 to 2001. All angiographic, clinical, and follow-up data were prospectively collected. According to the TIMI risk score, patients were stratified in low- and high-risk groups.

RESULTS: Preprocedural TIMI flow was related to postprocedural TIMI flow grade 3 (p = 0.002), myocardial blush grade 2 to 3 (p < 0.001), enzymatic infarct size (p < 0.001), predischarge ejection fraction (p < 0.001), and one-year mortality (p < 0.05). Multivariate analysis showed that preprocedural TIMI flow grade 3 was an independent predictor of one-year survival in high-risk patients (p < 0.05).

CONCLUSIONS: This study shows that preprocedural TIMI flow grade 3 is an independent predictor of one-year survival in high-risk patients with acute myocardial infarction treated by primary angioplasty. These data suggest that all efforts should be made to obtain early and optimal restoration of antegrade flow, particularly in high-risk patients and when transportation to tertiary centers, with a conceivable further time delay, is required.

Abbreviations and Acronyms
  CI = confidence interval
  EF = ejection fraction
  MBG = myocardial blush grade
  OR = odds ratio
  STEMI = ST-segment elevation myocardial infarction
  TIMI = Thrombolysis In Myocardial Infarction




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