Department of Cardiology, University Clinic Giessen, Germany.
Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen, Germany.
Catheter Cardiovasc Interv. 2020 Feb 15;95(3):494-500. doi: 10.1002/ccd.28318. Epub 2019 May 8.
This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST-elevation myocardial infarction (STEMI).
Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline-adherent therapy.
The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3.
From a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p < .05) and all-cause death (3.0, 1.4, and 2.1%, p = .30) were highest in patients with TIMI flow 0/1. After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74-4.85). However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. 1.3%, p < .05).
In this post-hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events.
本研究旨在分析急性 ST 段抬高型心肌梗死（STEMI）患者前向性心肌梗死溶栓试验（TIMI）血流分级对临床结局的影响。
先前的研究表明，直接经皮冠状动脉介入治疗（PCI）前 TIMI 血流 0/1 级与临床预后不良相关。然而，对于持续时间少于 6 小时、快速再灌注和现代指南一致治疗的 STEMI 患者，情况是否相同尚不清楚。
ATLANTIC 研究比较了急性 STEMI 患者院前与院内应用替格瑞洛的治疗效果。本分析中，根据梗死相关血管的术前 TIMI 血流分级，将患者分为三组：TIMI 0/1 级、TIMI 2 级和 TIMI 3 级。
在总共 1680 例患者中，1113 例患者在直接 PCI 前存在 TIMI 0/1 级血流，279 例患者存在 TIMI 2 级血流，288 例患者存在 TIMI 3 级血流。在 30 天时，TIMI 0/1 级血流患者的复合缺血终点事件（5.5%、2.9%和 2.1%，p<.05）和全因死亡（3.0%、1.4%和 2.1%，p=.30）发生率最高。校正后，术前 TIMI 血流<3 级（与 3 级相比）不是 30 天内主要不良缺血事件的独立预测因素（比值比 1.89，95%置信区间 0.74-4.85）。然而，仅在初始 TIMI 血流 0/1 级的患者中才发生明确的支架内血栓形成（1.0%）。在这些患者中，院前给予替格瑞洛的患者发生支架内血栓形成的比例较低（0.3% vs. 1.3%，p<.05）。
本事后分析中，术前 TIMI 血流与更高的不良缺血事件发生率无关。
