1 / 6

Gibson et al, Circulation 2002, 105:1909-1913

Relationship of the TIMI Myocardial Perfusion Grades, Flow Grades, Frame Count, and Percutaneous Coronary Intervention to Long-Term Outcomes After Thrombolytic Administration in Acute Myocardial Infarction.

xaviera-bowers
Download Presentation

Gibson et al, Circulation 2002, 105:1909-1913

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Relationship of the TIMI Myocardial Perfusion Grades, Flow Grades, Frame Count, and Percutaneous Coronary Intervention to Long-Term Outcomes After Thrombolytic Administration in Acute Myocardial Infarction • Although 90-minute TIMI flow grades (TFGs), corrected TIMI frame counts (CTFCs), and TIMI myocardial perfusion grades (TMPGs) have been associated with 30-day outcomes, we hypothesized that these indices would be related to long-term outcomes after thrombolytic administration. • We also hypothesized that in the modern era of interventional cardiology, that rescue and adjunctive PCI would be associated with improved long-term outcomes. • We also hypothesized that measures of flow before PCI would be associated with long-term outcomes Gibson et al, Circulation 2002, 105:1909-1913

  2. 90 Minute Pre PCI TIMI Flow Grade (TFG) is Associated with 2 Year Survival Following Thrombolytic Administration TFG 2 TFG 3 3- way log-rank p=0.0013 Survival TFG 0/1 In a MV model correcting for previously identified correlates of mortality (age, sex, pulse, left anterior descending artery infarction and any PCI during the index hospitalization), pre PCI patency (TFG 2/3)(HR0.32, p<0.001, pre PCI CTFC (p=0.01) and pre PCI TMPG 2/3 (HR 0.46, p=0.02) all remained independently associated with reduced 2 year mortality Years Gibson et al, Circulation 2002, 105:1909-1913

  3. Pre-PCI 90 Minute TMPG is Associated with 2 Year Survival Following Fibrinolytic Administration TMPG 2/3 Log rank p=0.03 TMPG 0/1 Survival Even after adjusting for the performance of adjunctive / rescue PCI, a closed myocardium before PCI was associated with poorer survival by 2 yrs Years Gibson et al, Circulation 2002, 105:1909-1913

  4. 2 Year Survival Following Rescue PCI in Patients with a Closed Artery Following Thrombolytic Administration Rescue PCI Log rank p=0.03 Survival No Rescue PCI Survival was Improved in patients with 90 minute TIMI Grade 0/1 Flow who underwent rescue PCI Years Gibson et al, Circulation 2002, 105:1909-1913

  5. 2 Year Survival Associated with Adjunctive PCI in Patients with an Open Artery Following Thrombolytic Administration Immediate Adjunctive PCI Delayed PCI No PCI p=0.11; after adjusting for stent use p=0.07 for adjunctive PCI Survival tended to be improved in patients with an open artery at 90 minutes who underwent immediate adjunctive or delayed PCI Years Gibson et al, Circulation 2002, 105:1909-1913

  6. Conclusions • Both improved epicardial flow (TFG 2/3 and low CTFCs) and tissue-level perfusion (TMPG 2/3) at 90 minutes after thrombolytic administration are independently associated with improved 2-year survival, suggesting complementary mechanisms of improved long-term survival. • Although rescue PCI was associated with reduced long-term mortality, improved microvascular perfusion (TMPG 2/3) before PCI was also related to improved mortality independently of epicardial blood flow and the performance of rescue or adjunctive PCI. • Further prospective trials are warranted to re-examine the benefit of early PCI with thrombolysis. Gibson et al, Circulation 2002, 105:1909-1913

More Related