TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention
Abstract
Background: Timely reperfusion, preferably by primary percutaneous intervention (PCI) has been the guiding-principle for the treatment of patients with acute ST-elevation myocardial infarction (STEMI). TIMI flow grade of the culprit lesion after the procedure have shown to have significant implication in clinical outcome.
Objective: We aimed to study the relation of TIMI flow grade with the in-hospital outcome and complication among patients of STEMI.
Methods: All consecutive acute STEMI patients undergoing primary PCI during the study period (January 2020 to June 2020) were analyzed for correlation between TIMI flow grade and clinical outcome during the hospital stay. Prior approval was taken from institutional review board. The study design was retrospective observational study.
Result: Total of 51(55%) patients had achieved the TIMI 3 flow after the primary PCI. Number of patients achieving TIMI flow of 2,1 and 0 after the procedure were 34(37%),6(6.5%) and 2(2%). Incidence of traditional risk factors like dyslipidemia, diabetes, hypertension was higher in TIMI flow <2 . TIMI flow <2 was also associated with more adverse events namely cardiogenic shock, arrythmias, in-hospital mortality and overall major adverse cardiovascular events.
Conclusion: Patients with dyslipidemia had poor TIMI flow grade during primary PCI. Similarly, patients having hypertension, diabetes mellitus and late presentation showed tendency for TIMI flow <2 . Also, the poor TIMI flow grade after primary PCI had unfavorable the clinical outcomes like increased complications and mortality.
Keywords: Primary percutaneous intervention (PCI), ST elevation MI (STEMI), TIMI flow grade
References
Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O’Keefe J, Overlie P, Donohue B, Chelliah N, Timmis GC, Vlietstra RE. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. New England Journal of Medicine. 1993;328(10):673-9. https://doi.org/10.1056/NEJM199303113281001 [Pubmed] [Google Scholar]
Boersma E, Mercado N, Poldermans D, Gardien M, Vos J, Simoons ML. Acute myocardial infarction. The Lancet. 2003;361(9360):847-58. https://doi.org/10.1016/S0140-6736(03)12712-2 [Pubmed] [Google Scholar]
Boden WE, Eagle K, Granger CB. Reperfusion strategies in acute ST-segment elevation myocardial infarction: a comprehensive review of contemporary management options. Journal of the American College of Cardiology. 2007;50(10):917-29. https://doi.org/10.1016/j.jacc.2007.04.084, [Pubmed] [Google Scholar]
Pohlen M, Bunzemeier H, HusemannW, Roeder N, Breithart G, Reinecke H (2008) Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs. Clin Res Cardiol 97(7):441–448. https://doi.org/10.1007/s00392-008-0647-8 [Pubmed] [Google Scholar]
Ribichini F, Ferrero V, Wijns W. Reperfusion treatment of ST-elevation acute myocardial infarction. Progress in cardiovascular diseases. 2004;47(2):131-57 https://doi.org/10.1016/j.pcad.2004.07.007 [Pubmed] [Google Scholar]
Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, O’Neill W, Grines CL, Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Journal of the American College of Cardiology. 2003;42(10):1739-46. https://doi.org/10.1016/j.jacc.2003.07.012 [Pubmed] [Google Scholar]
Mehta RH, Harjai KJ, Stone GW, Boura J, O’Neill W, Grines CL. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST elevation acute myocardial infarction. Am J Cardiol 2003;92:1445–7. https://doi.org/10.1016/j.amjcard.2003.08.056
Kenner MD, Zajac EJ, Kondos GT, Dave R, Winkelmann JW, Joftus J, Laucevicius A, Kybarskis A, Berukstis E, Urbonas A, Feinstein SB. Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up. The American journal of cardiology. 1995;76(12):861-8. https://doi.org/10.1016/S0002-9149(99)80250-1 [Pubmed] [Google Scholar]
Ito H, Maruyama A, Iwakura K, et al. Clinical implications of “no-reflow” phenomenon: a predictor of complications and left ventricular remodeling in perfused anterior wall infarction. Circulation 1996; 93:223– 8. https://doi.org/10.1161/01.CIR.93.2.223 [Pubmed] [Google Scholar]
Sun B, Liu J, Yin H, Yang S, Liu Z, Chen T, Li J, Guo C, Jiang Z. Delayed vs. immediate stenting in STEMI with a high thrombus burden. Herz. 2019 ;44(8):726-34. https://doi.org/10.1007/s00059-018-4699-x [Pubmed] [Google Scholar]
Bulluck H, Hammond-Haley M, Weinmann S, Martinez-Macias R, Hausenloy DJ. Myocardial Infarct Size by CMR in Clinical Cardioprotection Studies: Insights From Randomized Controlled Trials. JACC Cardiovasc Imaging. 2017;10(3):230-240 https://doi.org/10.1016/j.jcmg.2017.01.008 [Pubmed] [Google Scholar]
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C. Fourth universal definition of myocardial infarction. European heart journal. 2019;40(3):237-69. https://doi.org/10.1016/j.jacc.2018.08.1038 [Pubmed] [Google Scholar]
The TIMI Study Group (1985) The thrombolysis in myocardial infarction(TIMI) trial. NEJM 312(Suppl):932–936. https://doi.org/10.1056/NEJM198504043121437 [Pubmed] [Google Scholar]
Sarkar A, Grigg WS, Lee JJ. TIMI grade flow. StatPearls [Internet]. 2020 Aug 16. https://www.ncbi.nlm.nih.gov/books/NBK482412/ [Pubmed] [Google Scholar]
Sianos G, Papafaklis MI, Serruys PW. Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. Journal of invasive cardiology. 2010;22(10):6B-14B. [Pubmed] [Google Scholar]
Poudel I, Tejpal C, Rashid H, Jahan N. Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review. Cureus. 2019;11(7):e5280. https://doi.org/10.7759/cureus.5280 [Pubmed] [Google Scholar]
Ito H, Maruyama A, Iwakura K, et al. Clinical implications of ‘no-reflow’phenomenon: a predictor of complications and left ventricular remodeling in perfused anterior wall infarction. Circulation 1996; 93:223–8. https://doi.org/10.1161/01.CIR.93.2.223 [Pubmed] [Google Scholar]
Elakabawi K, Huang X, Shah SA, Ullah H, Mintz GS, Yuan Z, Guo N. Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI. BMC Cardiovascular Disorders. 2020; 20(1):1-2.https://doi.org/10.1186/s12872-020-01673 [Pubmed] [Google Scholar]
Kammler J, Kypta A, Hofmann R, Kerschner K, Grund M, Sihorsch K, Steinwender C, Lambert T, Helml W, Leisch F. TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction. Clin Res Cardiol. 2009;98(3):165-70. https://doi.org/10.1007/s00392-008-0735-9 [Pubmed] [Google Scholar]
Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, O’Neill W, Grines CL; Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003; 42(10):1739-46. https://doi.org/10.1016/j.jacc.2003.07.012
[Pubmed] [Google Scholar]
Gitt AK, Bauer T, Zahn R, Zeymer U, Hamm C. Non-achievement of TIMI-3-flow results in significant increase in hospital mortality of primary PCI for STEMI and PCI for NSTE-ACS-findings of the Euro Heart survey PCI-registry. European Heart Journal. 2013;34(suppl_1):109. https://doi.org/10.1093/eurheartj/eht307.109 [Pubmed] [Google Scholar]
Caixeta A, Lansky AJ, Mehran R, Brener SJ, Claessen B, Genereux P, et al. Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: results from the HORIZONS-AMI trial. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2013;9(2):220-7. https://doi.org/10.4244/EIJV9I2A37 [Pubmed] [Google Scholar]
Vichova T, Maly M, Ulman J, Motovska Z. Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion. Biomedical Papers. 2016 Mar 30;160(1):118-24. https://doi.org/10.5507/bp.2015.015 [Pubmed] [Google Scholar]
Copyright (c) 2021 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles published in EJMS are licensed under the Creative Commons Attribution 4.0 International License (CC-BY 4.0). The author(s) as the copyright holder will retain the ownership of the copyrights without any restrictions for their content under the CC-BY 4.0 license, and allow others to copy, use, print, share, modify, and distribute the content of the article even in commercial purpose as long as the original authors and the journal are properly cited. No permission is required from the author/s or the publishers. Appropriate attribution can be provided by simply citing the original article.
On behalf of all the authors, the corresponding author is responsible for completing and returning the agreement form to the editorial office. More information about the terms and conditions, privacy policies, and copyrights can be found on the webpage of the Creative Commons license privacy policy. https://creativecommons.org/licenses/by/4.0/
