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Journal of Thrombosis and Thrombolysis
Published in: Journal of Thrombosis and Thrombolysis 1/2014

01-07-2014

Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty

Authors: Giuseppe De Luca, Guido Parodi, Roberto Sciagrà, Francesco Venditti, Benedetta Bellandi, Ruben Vergara, Angela Migliorini, Renato Valenti, David Antoniucci

Published in: Journal of Thrombosis and Thrombolysis | Issue 1/2014

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Abstract

Despite optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim the current study was to evaluate the impact of preprocedural TIMI flow on myocardial scintigraphic infarct size among STEMI undergoing primary angioplasty. Our population is represented by 793 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Poor preprocedural TIMI flow (TIMI 0–1) was observed in 645 patients (81.3 %). Poor preprocedural TIMI flow was associated with more hypercholesterolemia (p = 0.012), and a trend in lower prevalence of diabetes (p = 0.081). Preprocedural TIMI flow significantly affected scintigraphic and enzymatic infarct size. Similar findings were observed in the analysis restricted to patients with postprocedural TIMI 3 flow. The impact of preprocedural TIMI flow on scintigraphic infarct size was confirmed when the analysis was performed according to the percentage of patients above the median (p < 0.001) and after adjustment for baseline confounding factors (Hypercholesterolemia and diabetes) [adjusted OR (95 % CI) for pre preprocedural TIMI 3 flow = 0.59 (0.46–0.75), p < 0.001]. This study shows that among patients with STEMI undergoing primary angioplasty, poor preprocedural TIMI flow is independently associated with larger infarct size.
Literature
1.
De Luca G, Cassetti E, Marino P (2009) Percutaneous coronary intervention-related time delay, patient’s risk profile, and survival benefits of primary angioplasty vs lytic therapy in ST-segment elevation myocardial infarction. Am J Emerg Med 27:712–719PubMedCrossRef
2.
De Luca G, Biondi-Zoccai G, Marino P (2008) Transferring patients with ST-segment elevation myocardial infarction for mechanical reperfusion: a meta-regression analysis of randomized trials. Ann Emerg Med 52:665–676PubMedCrossRef
3.
De Luca G, Cassetti E, Verdoia M, Marino P (2009) Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: a meta-analyis of randomised trials. Thromb Haemost 102:428–436PubMed
4.
De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann FJ, Van de Werf F, Antman EM, Topol EJ (2005) Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. JAMA 293:1759–1765PubMedCrossRef
5.
Di Lorenzo E, Sauro R, Varricchio A, Capasso M, Lanzillo T, Manganelli F, Mariello C, Siano F, Pagliuca MR, Stanco G, Rosato G, De Luca G (2009) Benefits of drug-eluting stents as compared to bare metal stent in ST-segment elevation myocardial infarction: four year results of the PaclitAxel or Sirolimus-Eluting stent vs bare metal stent in primary angiOplasty (PASEO) randomized trial. Am Heart J 158:e43–e50PubMedCrossRef
6.
7.
Sakuma T, Leong-Poi H, Fisher NG et al (2003) Further insights into the no-reflow phenomenon after primary angioplasty in acute myocardial infarction: the role of microthromboemboli. J Am Soc Echocardiogr 16:15–21PubMedCrossRef
8.
De Luca G, van’t Hof AW, Ottervanger JP, Hoorntje JC, Gosselink AT, Dambrink JH, Zijlstra F, de Boer MJ, Suryapranata H (2005) Unsuccessful reperfusion in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Am Heart J 150:557–562PubMedCrossRef
9.
Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, Weintraub RA, Kelly TA (1998) Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 32:1312–1319PubMedCrossRef
10.
Antoniucci D, Valenti R, Migliorini A, Moschi G, Trapani M, Buonamici P, Cerisano G, Bolognese L, Santoro GM (2002) Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am J Cardiol 89:1248–1252PubMedCrossRef
11.
De Luca G, van’t Hof AW, de Boer MJ, Ottervanger JP, Hoorntje JC, Gosselink AT, Dambrink JH, Zijlstra F, Suryapranata H (2004) Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. Eur Heart J 25:1009–1013PubMedCrossRef
12.
De Luca G, Suryapranata H, Ottervanger JP, Antman EM (2004) Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 109:1223–1225PubMedCrossRef
13.
Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, Krumholz HM, National Cardiovascular Data Registry (2009) Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 338:b1807. doi:10.​1136/​bmj.​b1807 PubMedCentralPubMedCrossRef
14.
Zahn R, Vogt A, Zeymer U, Gitt AK, Seidl K, Gottwik M, Weber MA, Niederer W, Mödl B, Engel HJ, Tebbe U, Senges J, Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (2005) In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte. Heart 91:1041–1046PubMedCentralPubMedCrossRef
15.
Stone GW, Cox D, Garcia E, Brodie BR, Morice MC, Griffin J, Mattos L, Lansky AJ, O’Neill WW, Grines CL (2001) Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 104:636–641PubMedCrossRef
16.
Brodie BR, Stuckey TD, Hansen C, Muncy D (2000) Benefit of coronary reperfusion before intervention on outcomes after primary angioplasty for acute myocardial infarction. Am J Cardiol 85:13–18PubMedCrossRef
17.
De Luca G, Ernst N, Zijlstra F, van ‘t Hof AW, Hoorntje JC, Dambrink JH, Gosslink AT, de Boer MJ, Suryapranata H (2004) Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 43:1363–1367PubMedCrossRef
18.
De Luca G, Ernst N, van’t Hof AW, Ottervanger JP, Hoorntje JC, Dambrink JH, Gosselink AT, de Boer MJ, Suryapranata H (2005) Preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute anterior myocardial infarction treated by primary angioplasty. Am Heart J 150:827–831PubMedCrossRef
19.
Dudek D, Rakowski T, El Massri N, Sorysz D, Zalewski J, Legutko J, Dziewierz A, Rzeszutko L, Zmudka K, Piwowarska W, De Luca G, Kaluza GL, Janion M, Dubiel JS (2008) Patency of infarct related artery after pharmacological reperfusion during transfer to primary percutaneous coronary intervention influences left ventricular function and one-year clinical outcome. Int J Cardiol 124:326–331PubMedCrossRef
20.
Maioli M, Zeymer U, van’t Hof AW, Gibson CM, Dudek D, Bellandi F, Noc M, Secco GG, Zorman S, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, Huber K, De Luca G, EGYPT Cooperation (2012) Impact of preprocedural TIMI flow on myocardial perfusion, distal embolization and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb/IIIa inhibitors. J Invasive Cardiol 24:324–327PubMed
21.
Ndrepepa G, Kastrati A, Schwaiger M, Mehilli J, Markwardt C, Dibra A, Dirschinger J, Schömig A (2005) Relationship between residual blood flow in the infarct-related artery and scintigraphic infarct size, myocardial salvage, and functional recovery in patients with acute myocardial infarction. J Nucl Med 46:1782–1788PubMed
22.
Sciagrà R, Imperiale A, Antoniucci D, Migliorini A, Parodi G, Comis G, Pupi A (2004) Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 31:969–974PubMedCrossRef
23.
O’Connor MK, Hammel T, Gibbons RJ (1990) In vitro validation of a simple tomographic technique for estimation of percentage myocardium at risk using methoxyisobutyl isonitrile technetium 99m (sestamibi). Eur J Nucl Med 17:69–76PubMedCrossRef
24.
De Luca G, Ernst N, Suryapranata H, Ottervanger JP, Hoorntje JC, Gosselink AT, Dambrink JH, de Boer MJ, van’t Hof AW (2005) Relation of interhospital delay and mortality in patients with ST-segment elevation myocardial infarction transferred for primary coronary angioplasty. Am J Cardiol 95:1361–1363PubMedCrossRef
25.
Reimer KA, Vander Heide RS, Richard VJ (1993) Reperfusion in acute myocardial infarction: effects of timing and modulating factors in experimental models. Am J Cardiol 72:13G–21GPubMedCrossRef
26.
Garcia-Dorado D, Theroux P, Elizaga J, Galinanes S, Solares J, Riesgo M, Gomez MJ, Garcia-Dorado A, Fernandez Aviles F (1987) Myocardial infarction in the pig heart model: infarct size and duration of coronary occlusion. Cardiovasc Res 21:537–544PubMedCrossRef
27.
Silvain J, Collet JP, Nagaswami C, Beygui F, Edmondson KE, Bellemain-Appaix A, Cayla G, Pena A, Brugier D, Barthelemy O, Montalescot G, Weisel JW (2011) Composition of coronary thrombus in acute myocardial infarction. J Am Coll Cardiol 57:1359–1367PubMedCentralPubMedCrossRef
28.
De Luca G, Gibson CM, Bellandi F, Noc M, Maioli M, Zorman S, Zeymer U, Gabriel HM, Emre A, Cutlip D, Arntz HR, Dudek D, Rakowski T, Gyongyosi M, Huber K, van’t Hof AW (2010) Impact of distal embolization on myocardial perfusion and survival among patients undergoing primary angioplasty with glycoprotein IIb-IIIa inhibitors: insights from the EGYPT cooperation. J Thromb Thrombolysis 30(1):23–28PubMedCrossRef
29.
Herrmann HC, Lu J, Brodie BR, Armstrong PW, Montalescot G, Betriu A, Neuman FJ, Effron MB, Barnathan ES, Topol EJ, Ellis SG, FINESSE Investigators (2009) Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to non percutaneous coronary intervention hospitals. JACC Cardiovasc Interv 2:917–924PubMedCrossRef
30.
De Luca G, Gibson CM, Bellandi F, Murphy S, Maioli M, Noc M, Zeymer U, Dudek D, Arntz HR, Zorman S, Gabriel HM, Emre A, Cutlip D, Biondi-Zoccai G, Rakowski T, Gyongyosi M, Marino P, Huber K, van’t Hof AW (2008) Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis. Heart 94:1548–1558PubMedCentralPubMedCrossRef
31.
De Luca G, Bellandi F, Huber K, Noc M, Petronio AS, Arntz HR, Maioli M, Gabriel HM, Zorman S, Carlo M DE, Rakowski T, Gyongyosi M, Dudek D (2011) Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient’s data meta-analysis. J Thromb Haemost 9:2361–2370CrossRef
32.
Dudek D, Siudak Z, Janzon M, Birkemeyer R, Aldama-Lopez G, Lettieri C, Janus B, Wisniewski A, Berti S, Olivari Z, Rakowski T, Partyka L, Goedicke J, Zmudka K, EUROTRANSFER Registry Investigators (2008) European registry on patients with ST-elevation myocardial infarction transferred for mechanical reperfusion with a special focus on early administration of abciximab—EUROTRANSFER Registry. Am Heart J 156:1147–1154PubMedCrossRef
33.
Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Taglieri N, Baldazzi F, Dall’Ara G, Nardini P, Gianstefani S, Guastaroba P, Grilli R, Branzi A (2009) Long-term effectiveness of early administration of glycoprotein IIb/IIIa agents to real-world patients undergoing primary percutaneous interventions: results of a registry study in an ST-elevation myocardial infarction network. Eur Heart J 30:33–43PubMedCrossRef
34.
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van’t Hof A, Widimsky P, Zahger D (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619PubMedCrossRef
35.
Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, Sulimov V, Rosell Ortiz F, Ostojic M, Welsh RC, Carvalho AC, Nanas J, Arntz HR, Halvorsen S, Huber K, Grajek S, Fresco C, Bluhmki E, Regelin A, Vandenberghe K, Bogaerts K, Van de Werf F, STREAM Investigative Team (2013) Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 368:1379–1387PubMedCrossRef
36.
Sinusas AJ, Shi Q, Vitols PJ, Fetterman RC, Maniawski P, Zaret BL, Wackers FJ (1993) Impact of regional ventricular function, geometry, and dobutamine stress on quantitative 99mTc-sestamibi defect size. Circulation 88:2224–2234PubMedCrossRef
Metadata
Title
Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty
Authors
Giuseppe De Luca
Guido Parodi
Roberto Sciagrà
Francesco Venditti
Benedetta Bellandi
Ruben Vergara
Angela Migliorini
Renato Valenti
David Antoniucci
Publication date
01-07-2014
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 1/2014
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-013-0977-x

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