Relationship between the door-to-TIMI-3 flow time and the infarct size in patients suffering from acute myocardial infarction: analysis based on the fibrinolysis and subsequent transluminal (FAST-3) trial.
BACKGROUND
The purpose of this study was to use the findings of a fibrinolysis and subsequent transluminal trial (FAST-3) to evaluate the association between the target time for obtaining a thrombolysis in myocardial infarction (TIMI)-3 flow after arrival at the emergency room with acute myocardial infarction (AMI) and the degree of myocardial salvage.


RESULTS
The FAST-3 trial was administered to 100 patients suffering from AMI. Ranges in the door-to-TIMI-3 flow time (D-T3-time: TIMI-3 flow after arrival at the emergency room) according to quartile were as follows: 30-54 min (quartile 1), 55-77 min (quartile 2), 78-120 min (quartile 3) and 121-330 min (quartile 4). Peak creatine kinase (CK), peak CK-MB, and peak troponin-T values increased in a stepwise fashion across the increasing quartiles of D-T3-time. The left ventricular end diastolic volume index at 30 days after the start of treatment showed low values for quartile 1. In multiple logistic regression analyses for independent predictors of myocardial damage, the adjusted odds ratios for myocardial damage (peak CK>3,000 U/L) in quartiles 3 and 4 of the D-T3-time were 4.0 (95% CI: 1.0-16.1) and 7.0 (95% confidence interval (CI): 1.4-36.0), respectively.


CONCLUSIONS
These findings suggest that physicians should monitor the D-T3-time for at least 55 min.
Watanabe
Kazuhiro
K
Department of Cardiology, Surugadai Nihon University Hospital, Tokyo, Japan. nabe2@zf7.so-net.ne.jp
Nagao
Ken
K
Watanabe
Ikuyoshi
I
Kanmatsuse
Katsuo
K
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D015425:Myocardial Reperfusion / Q000379:methods; D010343:Patient Admission / Q000706:statistics & numerical data; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013318:Stroke Volume; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D015415:Biomarkers; D005343:Fibrinolytic Agents; D007527:Isoenzymes; D011994:Recombinant Proteins; D020107:Troponin T; C468277:monteplase; D006493:Heparin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; C085027:pamiteplase; D001241:Aspirin