Clinical Significance of Post-Procedural TIMI Flow in Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

Mehta, Rajendra H.; Ou, Fang‐Shu; Peterson, Eric D.; Shaw, Richard E.; Hillegass, William B.; Rumsfeld, John S.; Roe, Matthew T.

doi:10.1016/j.jcin.2008.10.006

Cited by 56 publications

(31 citation statements)

References 28 publications

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“…Compared with TIMI flow grade 3 subgroup, postprocedural TIMI flow <3 in high-risk patients with STEMI treated by PPCI was associated with much higher enzymic infarction size, in-hospital and 1-year mortality, and lower predischarge ejection fraction, suggesting that efforts should be made to obtain early and optimal restoration of coronary flow. 38 However, in another trial, obtaining a better TIMI flow did not result either with better clinical outcomes or ejection fraction, nor did it result with lower mortality. 39 An association between bleeding and increased shortand long-term mortality has been well established.…”

Section: Discussionmentioning

confidence: 91%

Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register

Mrdović

Savić

Lasica

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Background: Studies with platelet glycoprotein IIb/IIIa receptor inhibitors (GPIs) showed conflicting results in primary percutaneous coronary intervention (PPCI) patients who were pretreated with 600 mg clopidogrel. We sought to investigate the short-and long-term efficacy and safety of the periprocedural administration of tirofiban in a largest Serbian PPCI centre. Methods: We analysed 2995 consecutive PPCI patients enrolled in the Clinical Center of Serbia STEMI Register, between February 2007 and March 2012. All patients were pretreated with 600 mg clopidogrel and 300 mg aspirin. Major adverse cardiovascular events, comprising all-cause death, nonfatal infarction, nonfatal stroke, and ischaemia-driven target vessel revascularization, was the primary efficacy end point. TIMI major bleeding was the key safety end point. Results: Analyses drawn from the propensity-matched sample showed improved primary efficacy end point in the tirofiban group at 30-day (OR 0.72, 95% CI 0.53-0.97) and at 1-year (OR 0.74, 95% CI 0.57-0.96) follow up. Moreover, tirofiban group had a significantly lower 30-day all-cause mortality (secondary end point; OR 0.63, 95% CI 0.40-0.90), compared with patients who were not administered tirofiban. At 1 year, a trend towards a lower all-cause mortality was observed in the tirofiban group (OR 0.74, 95% CI 0.53-1.04). No differences were found with respect to the TIMI major bleeding during the follow-up period. Conclusions: Tirofiban administered with PPCI, following 600 mg clopidogrel pretreatment, improved primary efficacy outcome at 30 days and at 1 year follow up without an increase in major bleeding.

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Section: Discussionmentioning

confidence: 91%

Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register

Mrdović

Savić

Lasica

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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“…Additionally, the lower effectiveness of PCI in CS patients evidenced by a lower proportion of angiographic success is of great clinical relevance. Several studies showed that patients without full restoration of flow in the infarct-related artery after PCI had significantly worse short- and long-term prognosis [32,33]. …”

Section: Discussionmentioning

confidence: 99%

Short- and Long-Term Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Stenting for Acute Myocardial Infarction Complicated by Cardiogenic Shock

Marcolino¹,

Şimşek²,

Boer³

et al. 2012

Cardiology

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Objectives: To determine the risk of short- and long-term mortality and major adverse cardiac events (MACE) in acute myocardial infarction (AMI) patients complicated by cardiogenic shock (CS) in the contemporary practice of primary percutaneous coronary intervention with stenting. Methods: Of the 1,755 consecutive AMI patients undergoing percutaneous coronary intervention with stenting enrolled, 103 had CS at admission. Primary endpoints were early mortality (within 30 days after the index event) and late mortality (from day 31 up to 4 years). Secondary endpoints included MACE [all-cause death, myocardial infarction or target vessel revascularization (TVR)], myocardial infarction, TVR and stent thrombosis. Results: Thirty-day mortality was higher among CS patients, and CS was a strong independent predictor of a higher risk of early death (adjusted HR 3.64, 95% CI 2.44–5.44). The late mortality rate was significantly higher in CS patients, and CS was also a predictor of higher risk of death at a 4-year follow-up (adjusted HR 1.95, 95% CI 1.11–3.45). Recurrent AMI, TVR and stent thrombosis rates were similar among patients with and without CS. Conclusion: CS complicating AMI is still a severe clinical event, mainly with regard to a significant higher risk of early mortality, but also associated with a worse prognosis in 30-day survivors.

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“…The post-procedural TIMI flow grade <3 has also been reported to be a risk factor of an early and late mortality in AMI [9]. Mehta et al showed that unsuccessful PCI, defined by TIMI < 3 after PCI, in STEMI patients with cardiogenic shock was associated with significantly higher in-hospital mortality rates [10]. Ndrepepa et al demonstrated that post-procedural, but not the baseline TIMI flow grade, was an independent risk factor of 1-year mortality in patients with acute coronary syndromes treated with early PCI [11].…”

Section: Discussionmentioning

confidence: 99%

The impact of unsuccessful percutaneous coronary intervention on short‐ and long‐term prognosis in STEMI and NSTEMI

Mazurek

Kowalczyk

Lenarczyk

et al. 2011

Cathet Cardio Intervent

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Clinical Significance of Post-Procedural TIMI Flow in Patients With Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

Abstract: Lack of procedural success (post-PCI TIMI flow grades 0 to 2 in the IRA) after primary PCI for STEMI among patients with cardiogenic shock is associated with a much higher risk of mortality compared with the risk for patients with normal post-PCI TIMI flow grade 3.

Cited by 56 publications

References 28 publications

Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register

Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register

Short- and Long-Term Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Stenting for Acute Myocardial Infarction Complicated by Cardiogenic Shock

The impact of unsuccessful percutaneous coronary intervention on short‐ and long‐term prognosis in STEMI and NSTEMI

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