title: Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients.
abstract: OBJECTIVE
  The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR).
  
  
  METHODS
  In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission.
  
  
  RESULTS
  A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group.
  
  
  CONCLUSIONS
  Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France. Electronic address: Mathieu.schaaf@gmail.com.
authors.forename: Mathieu Julien
authors.initials: MJ
authors.lastname: Schaaf
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France; INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Faculté de Médecine Lyon Est, F-69373 Lyon, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: University Hospital of Tours, Hopital Trousseau, Cardiology Division, Université François Rabelais, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.affiliation: University Hospital of Nîmes, Hôpital Universitaire Carémeau, Cardiology Division, Nîmes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Regional Hospital of Pau, Cardiology Division, Pau, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delarche
authors.affiliation: Regional Hospital of Aix-en-Provence, Cardiology Division, Aix en Provence, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Jouve
authors.affiliation: Thorax Institute, Invasive Cardiology Department, University Hospital of Nantes, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Guerin
authors.affiliation: University Hospital of Grenoble, Hôpital La Tronche, Cardiology Division, Grenoble, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Vanzetto
authors.affiliation: University Hospital of Bordeaux, Groupe Hospitalier Sud Pessac, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.affiliation: University Hospital of Strasbourg, Nouvel Hôpital Civil, Cardiology Division, Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.affiliation: University Hospital of Montpellier, Cardiology Division, UMR5203, UMR661, Universités Montpellier 1 and 2, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.affiliation: University Hospital of Toulouse, Hôpital Rangeuil, Université Paul Sabatier, Toulouse, France.
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.affiliation: Regional Hospital of Mulhouse, Hôpital Emile Müller, Cardiology Division, Mulhouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Roth
authors.affiliation: University Hospital of Angers, Cardiology Division, Angers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Prunier
authors.affiliation: University Hospital of Montpellier, Cardiology Division, UMR5203, UMR661, Universités Montpellier 1 and 2, Montpellier, France.
authors.forename: Thien Tri
authors.initials: TT
authors.lastname: Cung
authors.affiliation: University Hospital of Montpellier, Cardiology Division, UMR5203, UMR661, Universités Montpellier 1 and 2, Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sanchez
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
authors.affiliation: Radiology Department, CREATIS-LRMN, CNRS UMR 5220 - INSERM U630 - Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Revel
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Giraud
authors.affiliation: Radiology Department, CREATIS-LRMN, CNRS UMR 5220 - INSERM U630 - Université Claude Bernard Lyon 1, Lyon, France; University Hospital of Saint-Etienne, Radiology Department, Saint-Etienne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Croisille
authors.affiliation: Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France; INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Faculté de Médecine Lyon Est, F-69373 Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004617:Embolism / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D057234:Preoperative Period; D011446:Prospective Studies
keywords: Coronary circulation; Magnetic resonance imaging; Microvascular obstruction; Myocardial delayed enhancement; Myocardial infarction