Nammas Wail, Pietilä Mikko, Romppanen Hannu, Sia Jussi, DeBelder Adam, Karjalainen Pasi P
a Heart Center , Satakunta Central Hospital , Pori , Finland.
b Heart Center , Turku University Hospital , Turku , Finland.
Scand Cardiovasc J. 2017 Oct;51(5):248-254. doi: 10.1080/14017431.2017.1346278. Epub 2017 Jun 30.
We explored the predictors and outcome of poor, versus good, initial TIMI flow in patients with acute coronary syndrome (ACS).
We performed post-hoc analysis of a randomized trial of patients presenting with ACS who received 2 comparative stents. Poor initial TIMI flow was defined as baseline TIMI flow grade 0/1 at the initial coronary angiography. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction or ischemia-driven target lesion revascularization. Stent thrombosis (ST) was adjudicated according to the criteria of definite ST described by the Academic Research Consortium. Propensity score-matched analysis was performed. We report data after 5-year follow-up.
Of 827 patients enrolled, 279 (33.7%) had initial TIMI 0/1 flow. Median follow-up duration was 5.0 years. Presentation by ST-elevation myocardial infarction and target vessel other than left anterior descending artery predicted initial TIMI 0/1 flow. MACE rate was comparable between the 2 subgroups (14% versus 15.9%, in patients with poor versus good initial TIMI flow, respectively, p = .46). Individual endpoints were comparable (p > .05 for all). Definite ST was more frequent in patients with initial TIMI 0/1 flow (3.6% versus 1.5%, respectively, p = .048). This was driven by more frequent early events (30 days) (p = .036); late/very late events were comparable (p = 1.0).
Predictors of poor initial TIMI flow included presentation by ST-elevation myocardial infarction, and target vessel other than left anterior descending artery. Definite ST occurred more in patients with poor, versus good, initial TIMI flow, mainly driven by difference in early events.
我们探讨了急性冠状动脉综合征（ACS）患者初始TIMI血流不佳与良好的预测因素及预后情况。
我们对接受两种对比支架的ACS患者的一项随机试验进行了事后分析。初始TIMI血流不佳定义为初始冠状动脉造影时基线TIMI血流分级为0/1。主要终点是主要不良心脏事件（MACE）：包括心源性死亡、非致死性心肌梗死或缺血驱动的靶病变血运重建的复合终点。支架血栓形成（ST）根据学术研究联盟描述的明确ST标准进行判定。进行了倾向评分匹配分析。我们报告了5年随访后的资料。
在纳入的827例患者中，279例（33.7%）初始TIMI血流为0/1。中位随访时间为5.0年。ST段抬高型心肌梗死表现及非左前降支靶血管可预测初始TIMI血流0/1。两个亚组的MACE发生率相当（初始TIMI血流不佳与良好的患者分别为14%和15.9%，p = 0.46）。各个终点相当（所有p均>0.05）。初始TIMI血流为0/1的患者明确ST更常见（分别为3.6%和1.5%，p = 0.048）。这是由更频繁的早期事件（30天内）所致（p = 0.036）；晚期/极晚期事件相当（p = 1.0）。
初始TIMI血流不佳的预测因素包括ST段抬高型心肌梗死表现及非左前降支靶血管。明确ST在初始TIMI血流不佳的患者中比良好的患者更常见，主要由早期事件差异所致。
