Comparative Efficacy of Primary Angioplasty with Stent Implantation and Thrombolysis in Restoring Basal Coronary Artery Flow in Acute ST Segment Elevation Myocardial Infarction: Quantitative Assessment Using the Corrected TIMI Frame Count

Abstract

Following thrombolysis and primary percutaneous transluminal coronary angioplasty (PTCA) for acute ST segment elevation myocardial infarction, basal flow in the culprit artery is known to influence prognosis. The purpose of this study was to determine if differences exist in basal flow in culprit and nonculprit coronary arteries in patients with acute ST segment elevation myocardial infarction who were treated with thrombolysis or primary PTCA with stent implantation. Twenty patients were randomized to thrombolysis (with recombinant tissue plasminogen activator) and 24 to primary PTCA with stent implantation within 3 hours of onset of acute ST segment elevation myocardial infarction. Coronary angiography was performed 90-120 minutes after thrombolysis or immediately after PTCA with stent implantation and again at 18-36 hours after intervention in both groups. Patients who failed to achieve thrombolysis in myocardial infarction (TIMI) grade 2 or 3 flow were excluded. The corrected TIMI frame count was used as the index of basal coronary artery flow. Early after intervention the mean corrected TIMI frame count in the culprit coronary artery was significantly lower in the primary PTCA with stent group (27.4 +/- 7.7 frames) than in the thrombolysis group (39.8 +/- 10 frames, p < 0.001). Eight thrombolysis patients (40%) and 20 primary PTCA patients (83%, p < 0.01) achieved TIMI grade 3 flow early after intervention. By 18-36 hours after intervention there were no significant differences in the mean correct TIMI frame count between the thrombolysis and primary PTCA with stent groups. There were no significant differences in the mean corrected TIMI frame count between these two groups in the nonculprit coronary artery, either early after intervention or at 18-36 hours. In successfully reperfused coronary arteries following acute ST segment elevation myocardial infarction, primary angioplasty with stent implantation reestablished TIMI grade 2 or 3 flow faster and more effectively than thrombolysis did.

The Effects of Percutaneous Coronary Intervention on the Flow in Acute Coronary Syndrome Patients—Geometry in Focus

“…Third, any correlation between TFC and 2/3D parameters was investigated, examining STEMI and NSTEMI subgroups separately. As a cut-off for TFC changes, ≥3 vs. <3 groups were compared based on previous studies investigating the significance level on the number of frame change [ 19 , 20 , 21 ].…”

Management of failed thrombolysis after acute myocardial infarction: An overview of current treatment options

“…Nevertheless, it has been shown that the time to reperfusion after lytic failure influences both procedural success and in-hospital results with the best outcomes obtained when this period is less than 8 h [27,28]. Furthermore, recent trials have demonstrated that rescue percutaneous coronary angioplasty (PTCA) early after failed thrombolysis seems to be as effective and safe as primary PTCA [29][30][31][32][33]. Thus, a policy aimed at performing rescue PCI to restore normal coronary flow as soon as thrombolysis fails appears to be warranted.…”

Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation

“…Others have examined the effect of time of day on outcome in PCI, and found no effect. 86,87 Studies have suggested that the mortality after PCI is unchanged if the procedure is delayed by up to 6 hours, 88,89 although this may not hold for highrisk patients. The NSF for coronary heart disease aims for a standard of 60 minutes between calling for professional help and thrombolysis (Standard six).…”