The effects of TIMI flow before mechanical reperfusion therapy on the long term clinical outcomes in patients with acute ST-segment elevation myocardial infarction

Hong, Young Joon; Jeong, Myung Ho; Lim, Ji Hyun; Park, Hyung Wook; Kim, Han Gyun; Park, Ok Young; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND: Epicardial infarct-related artery patency is reliably assessed by the Thrombolysis In Myocardial Infarction flow grade (TFG), and this index is associated with clinical outcomes after fibrinolytics or primary angioplasty in patients with acute myocardial infarction (AMI). The aim of this study was to examine long-term clinical outcomes according to the pre-procedural TFG in AMI after percutaneous coronary intervention (PCI).
METHODS
A total of 132 patients with AMI who underwent PCI between July 2001 and December 2001 at Chonnam National University Hospital were divided into two groups according to the pre-procedural TFG: Group I (n=60, 62.7+/-9.2 years, male 66.7%) with TFG 0-1 and Group II (n=72, 61.6+/-11.1 years, male 68.1%) with TFG 2-3.
RESULTS
Hypertension was more prevalent in Group I than that in Group II (56.7% vs. 27.8%, p=0.001) and cardiogenic shock on admission was more frequently observed in Group I than that in Group II (20.0% vs. 5.6%, p=0.011). The left ventricular ejection fraction was lower in Group I than that in Group II (42.6+/-10.5% vs. 50.5+/-12.1%, p=0.022). The levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, white blood cell and monocyte counts were higher in Group I than in Group II. On diagnostic coronary angiogram, complex lesion was more frequently observed in Group I than that in Group II (53.4% vs. 36.2%, p<0.001). During 1-year clinical follow-up, the mortality was higher in Group I than that in Group II (10.0% vs. 1.4%, p=0.028), however, there were no significant differences in the incidences of restenosis and target lesion revascluarization between the two groups. The event-free survival rate was lower in Group I than that in Group II (60.0% vs. 79.2%, p=0.016). The independent predictors for major adverse cardiac events were cardiogenic shock, CRP >or=0.5 mg/dL, age >or=70 years, triple vessel disease, low pre-interventional TFG (0-1) and post-interventional TFG (0-2).
CONCLUSION
Low pre-procedural TFG is associated with hypertension, cardiogenic shock, left ventricular dysfunction, and high mortality, and low event-free survival during one-year clinical follow-up after PCI in AMI.