Herzzentrum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.
Eur Heart J Acute Cardiovasc Care. 2012 Jun;1(2):136-42. doi: 10.1177/2048872612447069.
Early restoration of blood flow of the infarct-related artery is associated with an improved outcome in patients with ST-elevation myocardial infarction (STEMI). Previous studies have shown a low mortality in patients with TIMI 3 flow before primary percutaneous coronary intervention (PCI). Most likely these patients had spontaneous recanalization of the infarct vessel and might constitute a low-risk subgroup. The purpose of the present analysis was to investigate whether TIMI 3 flow obtained with fibrinolysis before PCI is associated with a clinical outcome comparable to that in patients with spontaneous TIMI 3 flow.
Patients with STEMI <6 hours enrolled in the ASSENT-4 PCI study were randomized to facilitated PCI with tenecteplase or primary PCI. For this analysis, patients were divided into three groups according to the TIMI flow of the infarct vessel before PCI: TIMI 0/1, TIMI 2, and TIMI 3.
From a total of 1617 patients, 861 had TIMI 0/1, 279 had TIMI 2, and 477 TIMI 3 flow. The rates of TIMI 3 flow after PCI were 84.6, 89.7, and 95.6%, respectively. Complete ST resolution was observed most often in the TIMI 3 flow group (47.5, 53.6, and 58.6%). The incidence of cardiogenic shock (6.2, 5.5, and 3.6%) and 90-day mortality (6.1, 4.7, and 4.0%) were lowest in the group with TIMI 3 patency before PCI, respectively. The rate of TIMI 3 flow before PCI was higher in the facilitated PCI group than in the primary PCI group (43.9 vs. 15.2%). The 90-day mortality in patients with TIMI 3 before PCI was identical in the facilitated and the primary PCI groups (14/353, 4.0% vs. 5/124, 4.0%).
In this post-hoc analysis of ASSENT-4 PCI, TIMI grade 3 flow in the infarct-related artery before PCI, occurring either spontaneously or obtained by fibrinolysis, is associated with a higher TIMI patency after PCI, better improved ST resolution and a trend towards a favourable clinical outcome after 90 days.
ST 段抬高型心肌梗死（STEMI）患者梗死相关动脉的早期血流恢复与改善预后相关。先前的研究表明，在直接经皮冠状动脉介入治疗（PCI）前，出现 TIMI 3 级血流的患者死亡率较低。这些患者很可能自发地使梗死血管再通，可能构成低危亚组。本分析的目的是探讨 PCI 前溶栓获得的 TIMI 3 级血流是否与自发获得 TIMI 3 级血流的患者的临床预后相当。
ASSENT-4 PCI 研究中纳入的发病 6 小时内的 STEMI 患者被随机分配至接受替奈普酶辅助 PCI 或直接 PCI。对于这项分析，根据 PCI 前梗死相关血管的 TIMI 血流，患者被分为三组：TIMI 0/1 级、TIMI 2 级和 TIMI 3 级。
在总共 1617 例患者中，861 例患者的 TIMI 0/1 级、279 例患者的 TIMI 2 级和 477 例患者的 TIMI 3 级。PCI 后 TIMI 3 级血流的发生率分别为 84.6%、89.7%和 95.6%。TIMI 3 级血流组最常观察到完全 ST 段缓解（47.5%、53.6%和 58.6%）。心原性休克的发生率（6.2%、5.5%和 3.6%）和 90 天死亡率（6.1%、4.7%和 4.0%）最低的是 PCI 前 TIMI 3 级血流开放组。辅助 PCI 组患者的 PCI 前 TIMI 3 级血流率高于直接 PCI 组（43.9%比 15.2%）。PCI 前 TIMI 3 级血流患者的 90 天死亡率在辅助 PCI 组和直接 PCI 组之间相同（353 例患者中的 14 例[4.0%]比 124 例患者中的 5 例[4.0%]）。
在 ASSENT-4 PCI 的这项事后分析中，梗死相关动脉 PCI 前自发或通过溶栓获得的 TIMI 3 级血流与 PCI 后更高的 TIMI 再通率、更好的 ST 段改善和 90 天后临床预后的改善趋势相关。
