Hussain Muhammad, Kumar Rajesh, Ammar Ali, Alishan Syed, Muhammad Atif S, Farooq Fawad, Saghir Tahir, Khan Naveedullah, Hassan Rizvi Syed N, Ashraf Tariq
Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
Cureus. 2020 Dec 12;12(12):e12036. doi: 10.7759/cureus.12036.
Background ST elevation myocardial infarction (STEMI) is classically characterized by total occlusion of the culprit coronary artery. However during primary percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) 0 flow is not observed in all patients' culprit arteries in angiographic views. This study was conducted to find out the frequency of TIMI flow in acute STEMI patients in view of the above concept. The aim of this study was to evaluate the frequency of pre-procedural TIMI III flow in those patients who underwent primary PCI for acute STEMI in a public sector hospital in Karachi, Pakistan. Methodology This study is an audit of already saved data in the catheterization laboratory of the National Institute of Cardiovascular Diseases (NICVD), Karachi, that was collected prospectively from January 2016 to December 2018. These data were collected after taking consent from those patients who presented to hospital within 12 hours of symptoms and underwent primary PCI. Data were entered and analyzed on Statistical Package for the Social Sciences (SPSS) version 19 (IBM Corp., Armonk, NY, USA). Results A total of 8018 patients were included in this study who presented with STEMI and underwent primary PCI. Out of them 80.9% were males. Hypertension was the leading risk factor in 54.1% (4340) of patients. TIMI III flow was present in 11.4% of patients before primary PCI, while TIMI 0, I and II flow were present in 57.1%, 15.1%, and 16.3% of patients respectively (p<0.001). Fourteen percent of patients with TIMI III flow were of age group 51 to 60 years. Among those who had TIMI III flow, 11.2% were those with door to balloon time of <90 minutes. In 11% of cases, left anterior descending (LAD) artery had TIMI III flow as compared to other vessels (p<0.001). The length of the lesion was significantly smaller in patients who had TIMI III flow compared to those who had TIMI 0-II flow. Conclusions This study revealed that not all patients with acute STEMI had totally occluded culprit coronary artery but some of them had angiographic TIMI I-III flow in the infarct-related artery. Further studies are needed to find the reason for re-establishment of flow in the culprit vessel in STEMI patients before PCI.
背景 ST段抬高型心肌梗死（STEMI）的典型特征是罪犯冠状动脉完全闭塞。然而，在直接经皮冠状动脉介入治疗（PCI）期间，血管造影显示并非所有患者的罪犯动脉均出现心肌梗死溶栓治疗（TIMI）0级血流。鉴于上述概念，本研究旨在了解急性STEMI患者中TIMI血流的发生率。本研究的目的是评估在巴基斯坦卡拉奇一家公立医院接受急性STEMI直接PCI治疗的患者中，术前TIMI Ⅲ级血流的发生率。方法 本研究是对卡拉奇国家心血管疾病研究所（NICVD）导管实验室中已保存数据的审核，这些数据是在2016年1月至2018年12月期间前瞻性收集的。这些数据是在征得那些症状出现后12小时内入院并接受直接PCI治疗的患者同意后收集的。数据录入社会科学统计软件包（SPSS）19版（美国纽约州阿蒙克市IBM公司）并进行分析。结果 本研究共纳入8018例表现为STEMI并接受直接PCI治疗的患者。其中80.9%为男性。高血压是54.1%（4340例）患者的主要危险因素。直接PCI术前11.4%的患者存在TIMIⅢ级血流，而TIMI 0级、Ⅰ级和Ⅱ级血流分别存在于57.1%、15.1%和16.3%的患者中（p<0.001）。14%TIMIⅢ级血流的患者年龄在51至60岁之间。在那些有TIMIⅢ级血流的患者中，11.2%是门球时间<90分钟的患者。与其他血管相比，11%的病例中左前降支（LAD）动脉有TIMIⅢ级血流（p<0.001）。与TIMI 0 - Ⅱ级血流的患者相比，TIMIⅢ级血流的患者病变长度明显较短。结论 本研究表明，并非所有急性STEMI患者的罪犯冠状动脉都完全闭塞，其中一些患者梗死相关动脉存在血管造影TIMIⅠ - Ⅲ级血流。需要进一步研究以找出STEMI患者PCI术前罪犯血管血流重建的原因。
