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Association of a pulsatile blood flow pattern on coronary arteriography and short-term clinical outcomes in acute myocardial infarction

C. Michael Gibson, MS, MD^*,*, Juhana Karha, MD^*, Sabina A. Murphy, MPH^*, James A. de Lemos, MD, David A. Morrow, MD^*, Robert P. Giugliano, MD, SM^*, Mathew T. Roe, MD, MHS, Robert A. Harrington, MD, Christopher P. Cannon, MD^*, Elliott M. Antman, MD^*, Robert M. Califf, MD, Eugene Braunwald, MD^* TIMI Study Group

^* TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Duke Clinical Research Institute, Durham, North Carolina, USA

View larger version (15K): [in a new window]   Figure 1 (A) Incidence of 60-min Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow among patients with pulsatile versus nonpulsatile flow pattern. (B) Incidence of pulsatile flow among patients with TIMI flow grade (TFG) 2 and grade 3 at 60 min. PCI = percutaneous coronary intervention.

View larger version (23K): [in a new window]   Figure 2 (A) Median 60-min corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC) with interquartile range for patients with pulsatile versus nonpulsatile flow pattern. p value from Wilcoxon rank-sum test. (B) Incidence of pulsatile flow among patients with above versus below median (30.6 frames) (CTFC) at 60 min.

View larger version (15K): [in a new window]   Figure 3 (A) Incidence of TIMI myocardial perfusion grade (TMPG) 0 to 1 at 60 min among patients with pulsatile versus nonpulsatile flow pattern. (B) Incidence of pulsatile flow among patients with TMPG 0 to 1 versus TMPG 2 to 3 at 60 min.

View larger version (14K): [in a new window]   Figure 4 (A) Incidence of complete (70%) ST-segment resolution (ST Res) at 60 min among patients with pulsatile versus nonpulsatile flow pattern. p value from Fisher exact test. (B) Incidence of pulsatile flow among patients with complete (70%) versus incomplete ST Res at 60 min. p value from Fisher exact test. (C) Median ST Res with interquartile range at 60 min among patients with pulsatile versus nonpulsatile flow pattern.

View larger version (15K): [in a new window]   Figure 5 (A) Incidence of death or recurrent myocardial infarction (MI) at 30 days among patients with pulsatile versus nonpulsatile flow pattern at 60 min. (B) Incidence of pulsatile flow at 60 min among patients who died or sustained a recurrent MI within 30 days of the index MI versus patients who survived 30 days without recurrent MI.

View larger version (12K): [in a new window]   Figure 6 Kaplan-Meier curve for recurrent myocardial infarction through 30 days among patients with pulsatile versus nonpulsatile flow pattern at 60 min.