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Determinants of coronary blood flow after thrombolytic administration

C. Michael Gibson, MS, MD, FACC^*, Sabina Murphy, MPH^*, Ian B. A. Menown, MD, MRCP, Rafael F. Sequeira, MD, FACC, Robert Greene, MD, FACC, Frans Van de Werf, MD^||, Marc J. Schweiger, MD, FACC^¶, Magdi Ghali, MD, FACC^#, Martin J. Frey, MD, FACC^**, Kathryn A. Ryan, BS^*, Susan J. Marble, RN, MS^*, Robert P. Giugliano, MD, SM, Elliott M. Antman, MD, FACC, Christopher P. Cannon, MD, FACC, Eugene Braunwald, MD, FACC for the TIMI Study Group

^* Cardiovascular Division of the Department of Medicine, the University of California San Francisco, San Francisco, California, USA
Royal Victoria Hospital, Belfast, Northern Ireland, Ireland
Jackson Memorial Hospital, Miami, Florida, USA
Alta Bates Medical Center, Berkeley, California, USA
^|| UZ Gasthuisberg, Leuven, Belgium
^¶ Baystate Medical Center, Springfield, Massachusetts, USA
^# Iowa Heart Center/Mercy Hospital, Des Moines, Iowa, USA
^** Sarasota Memorial Hospital, Sarasota, Florida, USA
Brigham & Women’s Hospital, Boston, Massachusetts, USA

View larger version (16K): [in a new window]   Figure 1 Impact of PTCA and intracoronary stenting following thrombolytic administration on coronary blood flow. The percent distribution of the original 90-min TIMI flow grades among those patients who ultimately underwent stent placement is shown below the bar diagram. To the right of each bar is the percent of patients who went on to develop each of the TIMI flow grades following PTCA and stenting. For example, 34% of those patients who were stented had TIMI flow grade 0/1 at 90 min. Two percent of the patients who began with TIMI flow grade 0/1 remained occluded following the conventional PTCA, 28% went on to develop TIMI flow grade 2, and 70% went on to develop TIMI flow grade 3 after conventional PTCA. Following stent placement, no patients had TIMI flow grade 0/1, 12% had TIMI flow grade 2, and 88% had TIMI flow grade 3. The sample size of patients with PTCA data is reduced because the post-PTCA flow was not always filmed prior to stent placement.

View larger version (22K): [in a new window]   Figure 2 Shown is a cumulative distribution function of the distance of culprit lesions from the ostium in the setting of acute myocardial infarction. On the y-axis is the percentage of culprit lesions located within any given distance from the ostium shown on the x-axis. A greater percentage of LAD and circumflex culprit lesions lie closer to the ostium compared to the RCA.