TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

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

Download Full-text

Abstract 2833: Low Erythropoietin Serum Levels Are Associated With Angiographic No-reflow After Primary Intervention For Acute Myocardial Infarction

Circulation ◽

10.1161/circ.116.suppl_16.ii_630-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Giampaolo Niccoli ◽

Francesca Marzo ◽

Antonella Paglia ◽

Eleonora Santucci ◽

Cristina Spaziani ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Serum Levels ◽

St Elevation Myocardial Infarction ◽

Consecutive Series ◽

Primary Pci ◽

Timi Flow Grade ◽

No Reflow ◽

Timi Flow ◽

St Elevation

Background : No-reflow after primary percutaneous coronary intervention (PCI) remains a clinical challenge. Erythropoietin (EPO) has been associated with reduced infarct size due to EPO’s antiapoptotic and nitric oxide enhancing effects. We aimed to assess the association between EPO serum levels measured on admission and angiographic no-reflow in patients undergoing primary PCI. Methods : From a consecutive series of 60 patients presenting with ST elevation myocardial infarction within 12 h of chest pain onset and undergoing successful primary PCI (i.e. residual stenosis < 20%), we included 48 patients (age 61±12 years, male sex 89%), comprising the first 24 with no-reflow and the first 24 without no reflow. Patients with iron deficiency, recent transfusions, liver or lung failure, other haematological disorders or undergoing treatment with EPO were excluded. EPO levels were measured by ELISA before PCI. Clinical, enzymatic, procedural and angiographic data were also collected. No-reflow was defined as a coronary TIMI flow grade ≤ 2 after vessel reopening or as a TIMI flow grade of 3 with a final myocardial blush grade <2. Multivariate predictors of no-reflow were assessed by logistic regression analysis (SPSS 13). Results : Patients with and without no-reflow did not differ significantly in age, sex, cardiovascular risk factors or standard therapy for acute myocardial infarction. Thrombus aspiration was used in 16 patients (32%) whereas abciximab in 31 (63%), and they did not differ between the two groups. Patients with angiographic no-reflow had lower EPO serum levels compared to those having angiographic reflow (4.2 (0.56 –9.5) vs 12.2 (5.7–20.2) mUI/ml, p=0.001). The left anterior descending artery (LAD) was the culprit vessel in 83% of patients having no-reflow as compared to 30% of those having reflow (p<0.0001). At multivariate analysis, including EPO levels, culprit artery and symptoms to balloon time, the independent predictors of no-reflow were LAD as culprit vessel (OR 15, 95% CI 3–75, p=0.001) and low EPO serum levels (OR 0.91, 95% CI 0.84 – 0.99, p=0.048). Conclusion : These data suggest a significant role for EPO in modulating microcirculatory injury after mechanical reperfusion in patients with ST elevation myocardial infarction.

Download Full-text