Document Detail


Predictors and implications of coronary infarct artery patency at initial angiography in patients with acute myocardial infarction (from the CADILLAC and HORIZONS-AMI Trials).
MedLine Citation:
PMID:  21764028     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pre-percutaneous coronary intervention (PCI) Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow has been identified as a predictor of final TIMI grade 3 flow and better survival. Yet pharmacologic strategies increasing the rates of pre-PCI TIMI grade 3 flow resulted in more bleeding, without a benefit in survival. The aim of this study was to identify the predictors and implications of spontaneous reperfusion before primary PCI in patients with ST-segment elevation myocardial infarction. The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trials were combined, and the predictors of core laboratory-determined baseline TIMI grade 3 flow and 1-year outcomes were analyzed according to baseline TIMI flow. Baseline TIMI grade 3 flow was present in 932 of 5,332 patients (17.5%). The independent predictors of baseline TIMI grade 3 flow were diabetes, longer delay to PCI, smoking, and more extensive coronary disease. Patients with compared to those without baseline TIMI grade 3 flow had significantly higher rates of post-PCI TIMI grade 3 flow (99.1% vs 91.4%, p <0.0001) and lower 1-year all-cause mortality (2.7% vs 4.3%, p = 0.02). By multivariate analysis, baseline TIMI grade 3 flow (hazard ratio 1.65, 95% confidence interval 1.01 to 2.71, p = 0.046) and final TIMI grade 3 flow (hazard ratio 3.67, 95% confidence interval 2.45 to 5.48, p <0.001) were significant independent predictors of 1-year survival. In conclusion, TIMI grade 3 flow is present in about 1 in every 6 patients before PCI and paradoxically is more common in patients with higher risk characteristics. TIMI grade 3 flow before as well as after PCI is an independent predictor of greater 1-year survival. These data should inform future trials of ST-segment elevation myocardial infarction with respect to improvement in outcomes.
Authors:
Sorin J Brener; Roxana Mehran; Bruce R Brodie; Giulio Guagliumi; Bernhard Witzenbichler; Ecaterina Cristea; Ke Xu; Alexandra J Lansky; Gregg W Stone
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2011-07-20
Journal Detail:
Title:  The American journal of cardiology     Volume:  108     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-16     Completed Date:  2011-11-08     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  918-23     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
New York Methodist Hospital, Brooklyn, USA. sjb9005@nyp.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / methods
Antibodies, Monoclonal / pharmacology
Coronary Angiography*
Coronary Circulation / physiology*
Coronary Vessels / physiopathology*
Drug-Eluting Stents
Electrocardiography
Female
Follow-Up Studies
Humans
Immunoglobulin Fab Fragments / pharmacology
Male
Middle Aged
Myocardial Infarction / physiopathology,  radiography*,  surgery
Platelet Aggregation Inhibitors / pharmacology
Predictive Value of Tests
Regional Blood Flow
Vascular Patency / physiology*
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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