Significance of the Thrombolysis in Myocardial Infarction scoring system in assessing infarct-related artery reperfusion and mortality rates after acute myocardial infarction☆,☆☆,★,★★
Section snippets
Methods
Relevant studies were identified by a systematic MEDLINE search and references from selected studies. In this way, all postinfarction, postthrombolysis angiographic studies that included data on both TIMI grades at 90 minutes after thrombolysis and mortality rates were identified. Only articles that documented mortality rates for the individual TIMI grades were included in the metaanalysis.
Results
Five publications 2, 4, 5, 6, 9 were identified. One trial 4 contained the composite results from five studies, 10, 11, 12, 13, 14 one 5 from four studies, 15, 16, 17, 18 and one 9 from three 19, 20, 21 separate studies. All studies reported the in-hospital to 42-day mortality rate. Of 4687 patients, 1301 (28%) had TIMI 0/1, 996 (21%) had TIMI 2, and 2378 (51%) had TIMI 3 grade flow 90 minutes after initiation of thrombolytic therapy. The number of deaths was 120 (9.2%), 66 (6.6%), and 87
Discussion
This metaanalysis confirms the importance of achieving early and complete infarct-related artery patency for improving the survival rate after an acute infarct, with TIMI 3 flow leading to the lowest mortality rates. There is clearly a significant difference in mortality rate between TIMI 2 and TIMI 3 patients, confirming the general trend seen in recent trials 2, 3, 4, 5, 6 and verifying the view that TIMI 3 flow should be the only patency grade considered to represent reperfusion success.
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Cited by (36)
Management of STEMI in low- and middle-income countries
2014, Global HeartCitation Excerpt :In addition, the degree of flow is also important, resulting in the development of the TIMI flow grade (Figure 2) [106]. Mortality is lower among patients with TIMI flow grade 2 or 3, compared with TIMI flow grade 0 to 1, was achieved within 90 min after acute STEMI [107]. Therefore, the goal of reperfusion is not only early reperfusion but also restoration of normal flow (Figures 1 and 2).
Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction
2007, Canadian Journal of CardiologyReperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction. A Comprehensive Review of Contemporary Management Options
2007, Journal of the American College of CardiologyCitation Excerpt :The early-open-artery theory suggests that benefits of reperfusion in patients with STEMI are directly related to the speed and completeness with which patency of the infarct-related coronary artery is re-established. Mortality has been shown to be lower among patients in whom TIMI flow grade 2 to 3, compared with TIMI flow grade 0 to 1, was achieved within 90 min after acute MI (23). This is strongly supported by clinical studies confirming the important relationship between achieving prompt antegrade coronary flow of the infarct artery and improved clinical outcomes, for both primary PCI (22,24–27) and fibrinolysis (21,28,29).
Implantable defibrillator early after primary percutaneous intervention for ST-elevation myocardial infarction: Rationale and design of the Defibrillator After Primary Angioplasty (DAPA) Trial
2006, American Heart JournalCitation Excerpt :Two other very strong predictors of long-term mortality are TIMI flow after the primary PCI and LV function. The association between high mortality and impaired TIMI flow was already observed in the thrombolysis trials,17,18 showing that patients with normal epicardial blood flow and myocardial reperfusion have an excellent prognosis,19 but that incomplete reperfusion (TIMI 2 flow) was almost as bad as no reperfusion at all.20-22 Not surprisingly, also after primary PCI, TIMI flow less than 3 is a strong predictor of mortality.14,23
Coronary angiography: Beyond coronary anatomy
2006, Revista Espanola de Cardiologia
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From the MRC Clinical Sciences Center and Royal Postgraduate Medical School, and the Department of Cardiology, Hammersmith Hospital.
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Reprint requests: Farzin Fath-Ordoubadi, MRCP, MRC Cyclotron Unit, MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Rd., London W12 ONN, United Kingdom.
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E-mail: [email protected] or [email protected]
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