title: Preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute anterior myocardial infarction treated by primary angioplasty.
abstract: BACKGROUND
  Although the benefits of primary angioplasty for ST-segment elevation myocardial infarction (STEMI) have been demonstrated, the prognostic role of early recanalization in these patients has yet to be investigated. The aim of the study was to evaluate the impact of preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow on the extent of myocardial reperfusion in patients with anterior STEMI treated with primary angioplasty.
  
  
  METHODS
  Our population consisted of 754 consecutive patients with anterior STEMI treated by primary angioplasty from April 1997 to October 2001. All angiographic, clinical, and follow-up data were prospectively collected.
  
  
  RESULTS
  Preprocedural TIMI flow was related to postprocedural TIMI 3 flow (P < .0001), ST-segment resolution (P = .009), myocardial blush grade (P < .0001), enzymatic infarct size (P < .0001), and predischarge ejection fraction (P < .0001), even in the analysis restricted to patients with postprocedural TIMI 3 flow. These data explain the observed significant impact of preprocedural TIMI flow on 1-year mortality.
  
  
  CONCLUSIONS
  This study shows that in patients with anterior STEMI, poor preprocedural TIMI flow is associated with impaired perfusion, larger infarct size, and 1-year mortality. This study suggests that all efforts should be made to obtain optimal restoration of antegrade flow as early as possible before angioplasty. Further studies are needed to investigate the impact of early adjunctive pharmacological therapy on preprocedural TIMI flow and mortality in these high-risk patients.
authors.affiliation: ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Nicolette
authors.initials: N
authors.lastname: Ernst
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: Jan C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: Jan-Henk E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: A T Marcel
authors.initials: AT
authors.lastname: Gosslink
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
mesh_terms: D017130:Angioplasty; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D015912:Thrombolytic Therapy