Post-procedural TIMI flow grade 2 is not associated with improved prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization (PL-ACS registry).
BACKGROUND
The impact of final Thrombolysis in Myocardial Infarction (TIMI) flow in the infarct-related artery (IRA) on outcomes in non-ST-segment elevation myocardial infarc-tion (NSTEMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study aimed to evaluate the impact of post-procedural TIMI flow in IRA on outcomes in NSTEMI patients undergoing percutaneous coronary revascularization.


METHODS
We analyzed 2,767 patients with first NSTEMI from the Polish Registry of Acute Coronary Syndromes (PL-ACS) who underwent PCI. The patients were divided according to post-procedural culprit vessel TIMI (0-1: 90, 3.26%; 2: 61, 2.20%; 3: 2,616, 94.54%).


RESULTS
The following mortality values were obtained in TIMI 0-1, 2, and 3 groups, respec-tively: in-hospital, 12.22%, 13.11%, 1.72% (p < 0.0001); 1-month, 13.33%, 13.11%, 3.44% (p < 0.0001); 12-month, 15.56%, 16.39%, 6.50% (p < 0.0001); 36-month, 25.56%, 21.31%, 13.91% (p = 0.0007). Mortality rates in patients with final TIMI 0-1 and 2 were not signifi-cantly different. Optimal TIMI 3 was independently associated with baseline TIMI 2-3 (OR ± ± 95% CI: 7.070 [4.35-11.82]), p < 0.0001; higher ejection fraction (1.30 [1.03-1.63]), p = 0.0038; and family history of coronary artery disease (2.83 [1.17-8.11]), p = 0.0294. Type C lesion, previous heart failure, and PCI without stenting independently predicted suboptimal TIMI 0-2.


CONCLUSIONS
Only achieving final TIMI 3 in IRA improves outcomes in NSTEMI patients treated with percutaneous coronary revascularization. The mortality rate of near-normal TIMI 2 is comparable to that of TIMI 0-1 after PCI. (.
2nd Department of Coronary Artery Disease, Institute of Car diology, Warsaw, Poland. karwowski.jarek@gmail.com.
Jarosław
J
Karwowski
Lech
L
Poloński
Marek
M
Gierlotka
Mariusz
M
Gąsior
Maciej
M
Bęćkowski
Ilona
I
Kowalik
Hanna
H
Szwed
D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012042:Registries; D015607:Stents; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*
acute coronary syndrome; infarct-related coronary artery; non-ST-segment elevation myocardial infarction; percutaneous coronary intervention