title: Predictors of infarct artery patency after prehospital thrombolysis: the multicentre, prospective, observational OPTIMAL study.
abstract: OBJECTIVE
  To identify predictors of early TIMI 3 flow patency of the infarct-related artery after prehospital thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) using data from a "real-world" population, and to develop a nomogram for triaging patients to emergency angiography.
  
  
  METHODS
  Multicentre, observational, prospective, cohort study.
  
  
  METHODS
  79 Hospitals in France with a prehospital mobile intensive care unit and a coronary care unit with 24 h access to coronary angiography.
  
  
  METHODS
  997 Patients with STEMI.
  
  
  METHODS
  All patients received prehospital thrombolysis within 6 h of symptom onset and angiography was performed within 6 h of thrombolysis.
  
  
  METHODS
  Coronary patency (TIMI flow).
  
  
  RESULTS
  The median age of the population was 59 years and the sample comprised 18% women. After multivariable logistic regression analysis, predictors of TIMI 3 flow in the infarct-related artery were current/previous smoking (odds ratio (OR) = 1.60, 95% confidence interval 1.15 to 2.22), < or =5 leads with ST-segment elevation before thrombolysis (OR = 1.59, 1.12 to 2.25), Killip class I (OR = 1.96, 1.05 to 3.67), chest pain relief (OR = 1.62, 1.17 to 2.25) and ST-segment resolution > or =70% (OR = 1.76, 1.29 to 2.38). A nomogram was developed to assess the probability of TIMI 3 flow, according to smoking status, number of leads with ST elevation before thrombolysis, Killip class, chest pain relief and ST-segment resolution.
  
  
  CONCLUSIONS
  This study provides quantitative data for predicting success of prehospital thrombolysis. The nomogram is a simple tool for predicting likelihood of coronary patency, based on clinical and electrocardiographic data. It may help to identify patients who require emergency angiography and rescue percutaneous coronary intervention.
authors.affiliation: Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France. bongard@cict.fr
authors.forename: V
authors.initials: V
authors.lastname: Bongard
authors.forename: J
authors.initials: J
authors.lastname: Puel
authors.forename: D
authors.initials: D
authors.lastname: Savary
authors.forename: L
authors.initials: L
authors.lastname: Belle
authors.forename: S
authors.initials: S
authors.lastname: Charpentier
authors.forename: Y
authors.initials: Y
authors.lastname: Cottin
authors.forename: L
authors.initials: L
authors.lastname: Soulat
authors.forename: M
authors.initials: M
authors.lastname: Elbaz
authors.forename: D
authors.initials: D
authors.lastname: Miljkovic
authors.forename: Ph G
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D004632:Emergency Medical Services; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*