title: High incidence of TIMI flow 0 to I in patients with ST-elevation myocardial infarction without electrocardiographic lytic criteria.
abstract: BACKGROUND
  Most patients with ST-elevation myocardial infarction fulfilling ST-segment elevation (STE) lytic criteria present an occluded culprit artery but the occlusion rate in those with minimal STE (minSTE) not fulfilling lytic criteria is unknown.
  
  
  METHODS
  In 63 patients with minSTE (mean STE:1.2 +/- 0.6 mm) and 149 with lytic STE criteria (lyticSTE, 4.8 +/- 3.1 mm), an emergency coronary angiography was performed, serial creatine kinase-MB was determined, and ejection fraction was measured by 2-dimensional echocardiography.
  
  
  RESULTS
  The 2 groups showed similar time from pain onset to electrocardiogram (minSTE 196 +/- 199 vs lyticSTE, 176 +/- 172 min, P = .444), and although time to catheterization was longer in patients with minSTE (426 +/- 314 vs 253 +/- 239 min, P < .001), the rate of TIMI flow 0 to I (88% vs 81%, P = .21) was similar and percutaneous coronary intervention was performed in >80% of patients from the 2 groups. Moreover, patients with minSTE had higher rate of collateral circulation (27% vs 13%, P = .013), lower rate of Q waves (44% vs 60%, P = .041), lower creatine kinase-MB (202 +/- 150 vs 335 +/- 280, microg/L, P < .001), higher ejection fraction (54% +/- 9% vs 49% +/- 12%, P = .004), and lower mortality (0% vs 7.4%, P = .036).
  
  
  CONCLUSIONS
  ST-elevation myocardial infarction patients with minSTE present a high prevalence of TIMI flow 0 to I similar to those meeting lyticSTE suggesting an identical underlying mechanism and the potential to benefit from primary angioplasty.
authors: Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5751jfb@comb.es
authors: Jaume
authors: J
authors: Figueras
authors: Ignacio
authors: I
authors: Ferreira-González
authors: Marcelo
authors: M
authors: Rizzo
authors: Oscar
authors: O
authors: Alcalde
authors: José A
authors: JA
authors: Barrabés
authors: Enric
authors: E
authors: Domingo
authors: Rosa M
authors: RM
authors: Lidón
authors: Josefa
authors: J
authors: Cortadellas
mesh_terms: D003326:Coronary Circulation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D011446:Prospective Studies