title: Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: results from the HORIZONS-AMI trial.
abstract: OBJECTIVE
  The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study.
  
  
  RESULTS
  The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5%) and 2,758 patients (87.1%) had final TIMI 3 flow, while 407 (12.9%) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95% CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95% CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95% CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; p<0.0001).
  
  
  CONCLUSIONS
  In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Bimmer
authors.initials: B
authors.lastname: Claessen
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D000991:Antithrombins / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D010975:Platelet Aggregation Inhibitors