title: Relation between injections before 90-minute angiography and coronary patency: results of the thrombolysis in myocardial infarction 4 trial.
abstract: The current goal of thrombolytic therapy is to achieve both full (Thrombolysis in Myocardial Infarction [TIMI] grade 3) and early reperfusion. Newer reperfusion strategies may now achieve a high degree of reperfusion even earlier than the traditional 90-minute end point. To determine whether injections before 90 minutes affect this traditional end point, the relation between the number of injections before 90-minute angiography and patency was examined in the TIMI 4 trial. The number of injections before 90-minute angiography was no different between occluded arteries (TIMI grade 0/1 flow) (2.46 +/- 1.78; n = 94) and patent arteries (TIMI grade 2/3 flow) (2.71 +/- 2.42; n = 295) (p = 0.24). The incidence of any injections before 90 minutes was no different in patent versus closed arteries (80.6% [77/98] vs 72.4% [22/304]; p = 0.10). The number of injections before 90 minutes was insignificantly smaller in patients with TIMI grade 3 flow (2.53 +/- 2.53 [n = 184] vs 2.76 +/- 2.03 [n = 204]; p = 0.31), but the incidence of any injections before 90 minutes was significantly smaller in patients with TIMI grade 3 flow (68.8% [132/192] vs 79.5% [167/210]; p = 0.01). No relation was identified between the number of injections before 90-minute angiography and patency at this traditional time point. This observation justifies the judicious use of a limited number of "earlier snapshots" of the infarct-related artery before 90 minutes to ascertain just how rapidly newer thrombolytic regimens achieve patency. Patients with TIMI grade 3 flow had a slightly lower incidence of injections before 90 minutes, perhaps because they did not require as urgent a definition of coronary anatomy.
authors.affiliation: Department of Medicine, Brigham and Women's Harvard Medical School, Boston, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Gibson
authors.forename: S J
authors.initials: SJ
authors.lastname: Marble
authors.forename: M J
authors.initials: MJ
authors.lastname: Rizzo
authors.forename: J
authors.initials: J
authors.lastname: Moynihan
authors.forename: C
authors.initials: C
authors.lastname: McLean
authors.forename: K
authors.initials: K
authors.lastname: Ryan
authors.forename: A
authors.initials: A
authors.lastname: Sparano
authors.forename: R N
authors.initials: RN
authors.lastname: Piana
authors.forename: C
authors.initials: C
authors.lastname: McCabe
authors.forename: C P
authors.initials: CP
authors.lastname: Cannon
mesh_terms: D000368:Aged; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D015425:Myocardial Reperfusion / Q000379:methods*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents