Document Detail


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.
MedLine Citation:
PMID:  22781470     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite optimal epicardial recanalization, primary angioplasty for ST-elevation myocardial infarction (STEMI) is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim of the current study was to evaluate the impact of preprocedural TIMI flow on myocardial perfusion, distal embolization, and survival among STEMI patients undergoing primary angioplasty with glycoprotein (GP) IIb/IIIa inhibitors.
METHODS: Our population is represented by a total of 1637 patients undergoing primary angioplasty for STEMI treated with GP IIb/IIIa inhibitors. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty.
RESULTS: Poor preprocedural TIMI flow (TIMI 0-1) was observed in 1039 patients (63.5%), and was associated with higher Killip class at presentation (P=.006), longer time-to-treatment (P=.03), less often with early administration of GP IIb/IIIa inhibitors (P<.001), impaired postprocedural epicardial (P=.001) and myocardial perfusion (determined by myocardial blush grade, P<.001 and/or ST-segment resolution (P<.001), and distal embolization (P=.041). At 206 ± 158 days follow-up, poor preprocedural recanalization was associated with a significantly higher mortality (adjusted odds ratio, 0.58; 95% CI, 0.34-0.96; P=.034).
CONCLUSION: This study shows that among patients with STEMI undergoing primary angioplasty with GP IIb/IIIa inhibitors, poor preprocedural TIMI flow is associated with higher incidence of distal embolization and impaired epicardial and myocardial perfusion, and significantly higher mortality.
Authors:
Mauro Maioli; Uwe Zeymer; Arnoud W J van 't Hof; C Michael Gibson; Dariusz Dudek; Francesco Bellandi; Marko Noc; Gioel Gabrio Secco; Simona Zorman; H Mesquita Gabriel; Ayse Emre; Donald Cutlip; Tomasz Rakowski; Maryann Gyongyosi; Kurt Huber; Giuseppe De Luca;
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  24     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-11     Completed Date:  2013-01-14     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  324-7     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Prato Hospital, Prato, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / methods*
Antibodies, Monoclonal / therapeutic use
Combined Modality Therapy
Electrocardiography*
Female
Follow-Up Studies
Humans
Immunoglobulin Fab Fragments / therapeutic use
Incidence
Male
Middle Aged
Myocardial Infarction / mortality*,  physiopathology,  therapy*
Peptides / therapeutic use
Platelet Aggregation Inhibitors / therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Regional Blood Flow / physiology*
Regression Analysis
Retrospective Studies
Risk Factors
Survival Rate
Thrombosis / epidemiology*,  physiopathology*
Treatment Outcome
Tyrosine / analogs & derivatives,  therapeutic use
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Peptides; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/eptifibatide; 144494-65-5/tirofiban; 55520-40-6/Tyrosine; X85G7936GV/abciximab

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