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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Prognostic Significance of Epicardial Blood Flow Before and After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes

Gjin Ndrepepa, MD^_*,_*, Julinda Mehilli, MD^_*, Stefanie Schulz, MD^_*, Raisuke Iijima, MD^_*, Dritan Keta, MD^_*, Robert A. Byrne, MD^_*, Jürgen Pache, MD^_*, Melchior Seyfarth, MD^_*, Albert Schömig, MD^_*, and Adnan Kastrati, MD^_*

^_* Deutsches Herzzentrum, Munich, Germany
1. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany.

Manuscript received March 10, 2008; revised manuscript received April 28, 2008, accepted May 5, 2008.

^_* Reprint requests and correspondence: Dr. Gjin Ndrepepa, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. (Email: ndrepepa{at}dhm.mhn.de).

Objectives: The aim of the study was to assess the relationship between baseline and post-procedural Thrombolysis In Myocardial Infarction (TIMI) epicardial blood flow grade and mortality in patients with acute coronary syndromes (ACS) who were treated with early percutaneous coronary intervention (PCI).

Background: The impact of baseline and post-procedural TIMI flow grade on mortality in patients with ACS has been insufficiently studied.

Methods: This prospective registry included 10,455 patients with ACS who underwent coronary angiography and PCI: 2,853 patients with ST-segment elevation acute myocardial infarction, 3,060 patients with non–ST-segment elevation acute myocardial infarction, and 4,542 patients with unstable angina. The primary outcome was 1-year mortality.

Results: At 1 year, there were 976 deaths: 117 deaths among patients with TIMI flow grade 0 to 1, 105 deaths among patients with TIMI flow grade 2, and 754 deaths among patients with TIMI flow grade 3 (Kaplan-Meier estimates of mortality 28.3%, 18.4%, and 8.0%, respectively; odds ratio: 1.66, 95% confidence interval [CI]: 1.57 to 1.76, p < 0.001, for TIMI flow grade 0 to 1 vs. TIMI flow grade 2 and odds ratio: 2.51, 95% CI: 2.06 to 3.06, p < 0.001, for TIMI flow grade 2 vs. TIMI flow grade 3). By using the Cox proportional hazards survival model, we identified post-PCI TIMI flow grade (hazard ratio: 0.60, 95% CI: 0.52 to 0.70; p < 0.001, for 1 grade increase in TIMI flow grade) but not baseline TIMI grade (hazard ratio: 1.08, 95% CI: 0.96 to 1.22; p = 0.20, for 1 grade increase in TIMI flow grade) as an independent correlate of 1-year mortality.

Conclusions: In patients with ACS treated with early PCI, post-procedural TIMI flow grade but not baseline TIMI flow grade is an independent correlate of 1-year mortality.

Key Words: acute coronary syndrome • mortality • percutaneous coronary intervention • TIMI flow grade

Abbreviations and Acronyms   ACS = acute coronary syndromes   CI = confidence interval   HR = hazard ratio   OR = odds ratio   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction

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J. Am. Coll. Cardiol. 2008 52: A33-A34. [Full Text] [PDF]