Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Mehta, Rajendra H.; Harjai, Kishore J.; Cox, David A.; Stone, Gregg W.; Brodie, Bruce R.; Boura, Judy; O’Neill, William W.; Grines, Cindy L.

doi:10.1016/j.jacc.2003.07.012

Cited by 161 publications

(102 citation statements)

References 36 publications

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“…The results were consistent with previous studies evaluated predictors of TIMI 2 in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary PCI. 6,15 Our study also demonstrated that statin was also an independent predictor for the no-reflow, which was consistent with the report of Iwakura. 16…”

Section: Predictors Of No-reflowsupporting

confidence: 91%

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Chronic pretreatment of ACEI reduces no‐reflow in patients with acute myocardial infarction treated with primary angioplasty

Zhao

Yang

Zhang

et al. 2007

Clinical Cardiology

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SummaryBackground: In animal models, pretreatment with angiotensin-converting enzyme inhibitor (ACEI) can reduce no-reflow. In the present study, we investigated whether pretreatment with ACEI may prevent no-reflow in patients who underwent primary coronary intervention for AMI.Method and Results: A total of 259 consecutive patients who underwent primary angioplasty for a first AMI were studied. No-reflow was defined as a TIMI flow grade <3. The no-reflow phenomenon was found in 33 of 259 patients. There were no significant differences in clinical characteristics between the patients with and without ACEI pretreatment. However, the 47 patients receiving chronic ACEI treatment before admission had lower incidence of the no-reflow than those without it (4.2 and 14.6%, p < 0.05). Multivariable logistic regression analysis revealed that absence of ACEI pretreatment was a significant predictor of the no-reflow along with absence of preinfarction angina, complete occlusion of the culprit lesion, high-burden thrombus, ejection fraction on admission, number of Q-waves, absence of statin pretreatment, and anterior AMI.

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Section: Predictors Of No-reflowsupporting

confidence: 91%

“…However, previous studies have identified greater size of the risk area is closely related to the no-reflow phenomenon. 15 The doses of ACEI in the study may be lower than the maximal recommended doses. This may lead to an underestimation of the effect of ACEI on noreflow.…”

Section: Limitation Of the Studymentioning

confidence: 98%

Chronic pretreatment of ACEI reduces no‐reflow in patients with acute myocardial infarction treated with primary angioplasty

Zhao

Yang

Zhang

et al. 2007

Clinical Cardiology

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“…Previous studies identified DM, age, hypertension, and pre-PCI TIMI flow as the independent predictors for suboptimal coronary flow. [33][34][35] In this study, postprocedural suboptimal coronary flow was diagnosed by coronary angiography and we found that LVEF, HDL cholesterol, Hb in STEMI and culprit vessel type, and the extent of multivessel disease in NSTEMI were the independent predictors for postprocedural suboptimal coronary flow after PCI.…”

Section: Discussionmentioning

confidence: 61%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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SummaryThis study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI !2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.(Int Heart J 2017; 58: 674-685)

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“…The success rate of achieving the postprocedural TIMI 3 flow and related patient characteristics in the present study conform to other studies: patients with postprocedural TIMI <3 flow were older, more commonly women, diabetics, with more frequent initial hemodynamic instability (Table 1) (ref. 9,16 ). Current smoking was associated with lower incidence of postprocedural TIMI <3 flow, which was observed previously in studies with thrombolysis in AMI (ref.…”

Section: Timi-3 Flow As An Outcome Predictormentioning

confidence: 99%

Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion

Vichova¹,

Malý²,

Ulman³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/ bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion. Methods. Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/ BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion. Results. A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction < 30% (P = 0.006), age > 65 years (P < 0.001), Killip class >2 (P <0.001), female gender (P = 0.019), and creatinine clearance < 30 mL/min (P < 0.001). Conclusion. Time delay to reperfusion is significantly related to 1-year mortality of patients with STEMI/BBB-MI and complete restoration of epicardial blood flow in culprit vessel after PCI.

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Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 161 publications

References 36 publications

Chronic pretreatment of ACEI reduces no‐reflow in patients with acute myocardial infarction treated with primary angioplasty

Chronic pretreatment of ACEI reduces no‐reflow in patients with acute myocardial infarction treated with primary angioplasty

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion

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