Impact of preprocedural TIMI flow on clinical outcome in low‐risk patients with ST‐elevation myocardial infarction: Results from the ATLANTIC study

Abstract

OBJECTIVES This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST‐elevation myocardial infarction (STEMI). BACKGROUND Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline‐adherent therapy. METHODS The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3. RESULTS From a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p < .05) and all‐cause death (3.0, 1.4, and 2.1%, p = .30) were highest in patients with TIMI flow 0/1. After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74–4.85). However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. 1.3%, p < .05). CONCLUSION In this post‐hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events.

Temporal trends in the pre-procedural TIMI flow grade among patients with ST- segment elevation myocardial infarction – From the ACSIS registry

“…It has proven to be an effective clinical tool. Preprocedural TIMI grade flow has been shown to stratify patients at risk for increased MACE and mortality post STEMI [3] , [4] , [7] . Although the clinical outcomes of STEMI patients have improved throughout the years, the prognosis of these patients has not changed equally.…”

Predictive Value of Soluble Growth Stimulator Gene 2 Protein for Coronary Slow Flow/No-Reflow in ST-Elevation Myocardial Infarction Patients Receiving Percutaneous Coronary Intervention

“…The coronary flow velocity was determined using the TIMI frame count method (30 frames/s). It was defined as the first frame when the contrast agent touched the two medial walls of the coronary artery and the diameter of the stained vessel was more than 70%, and it was defined as the last frame when the contrast agent reached the end of each branch of the coronary artery [ 8 ]. CSF/NRF was defined as a corrected TIMI frame count (cTFC) of >27 frames for the target vessel during PCI, and patients with coronary artery dissection [ 9 ] were excluded [ 10 ].…”

Accuracy of Fibrinogen/D-dimer Ratio in Predicting the Occurrence of Coronary Slow Flow Phenomenon

“…Coronary slow flow phenomenon (CSFP) is the presence of slow flow in one or more coronary artery branching vessels that are seen during contrast angiographic actions. There are differences in defining CSFP; it has been reported that the range of events is 1-7% in the angiographic series and up to 5% in cases of an acute coronary syndrome (ACS) [1], [2]. There are two methods of measuring the slow flow phenomenon [2].…”

“…The first method is thrombolysis in myocardial infarction (TIMI) flow grade from contrast scores ranging from TIMI 0 (no flow), TIMI 1 (penetration without perfusion), TIMI 2 (flow, including delayed filling), and TIMI 3 (normal flow, opacification of distal vessels in <3 s). The second method is the corrected TIMI frame count, which is the number of frames needed by contrast material to reach a specific distal coronary artery point with a standard range of 21 ± 3.5 [1], [3].…”