Relation of hyperemic epicardial flow to outcomes among patients with ST-segment elevation myocardial infarction receiving fibrinolytic therapy

The American Journal of Cardiology
C Michael GibsonE Braunwald

Abstract

In patients with ST-segment elevation myocardial infarction (STEMI), the restoration of normal epicardial flow following fibrinolytic administration is associated with improved clinical outcomes. The goal of this analysis was to examine the relation between hyperemic flow and outcomes following fibrinolytic administration for STEMI. In Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis In Myocardial Infarction 28 (CLARITY-TIMI 28), patients with STEMI (n=3,491) treated with fibrinolytic therapy were scheduled to undergo angiography 48 to 192 hours after randomization. Corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) were assessed, and their associations with outcomes at 30 days were evaluated. When evaluating initial angiography of the infarct-related artery, there was a nearly linear relation between CTFC and 30-day mortality, with faster flow (lower CTFC) associated with improved outcomes. Conversely, in patients who underwent percutaneous coronary intervention (PCI), very fast flow (CTFC<14) after intervention was associated with worse outcomes. Post-PCI hyperemic flow (CTFC<14) was associated with a higher incidence of mortality (p=0.056), recurrent myocardial infarction (p=0.011), and a ...Continue Reading

References

Jul 1, 1989·Progress in Cardiovascular Diseases·L BelardinelliR M Berne
Jan 15, 2002·American Journal of Physiology. Heart and Circulatory Physiology·Andreas SkyschallyGerd Heusch
Mar 3, 2005·European Heart Journal·Claudio CavalliniUNKNOWN Italian 'Atherosclerosis, Thorombosis, and Vascular Biology' and 'Society for Invasive Cardiology-GISE' Investigators
Mar 11, 2005·The New England Journal of Medicine·Marc S SabatineUNKNOWN CLARITY-TIMI 28 Investigators

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Citations

May 21, 2014·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Süleyman KarakoyunMahmut Acikel
Mar 31, 2021·Heart, Lung & Circulation·Annette Maznyczka, Peter A J Haworth

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