Document Detail


Significance of a coronary artery with thrombolysis in myocardial infarction grade 2 flow "patency" (outcome in the thrombolysis and angioplasty in myocardial infarction trials). Thrombolysis and Angioplasty in Myocardial Infarction Study Group.
MedLine Citation:
PMID:  7732992     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To determine whether pharmacologic reperfusion to Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow during acute myocardial infarction confers the same clinical benefit as restoration of TIMI 3 flow, in-hospital clinical and angiographic outcomes in 1,229 patients prospectively enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction trials were analyzed. Patients were treated with intravenous tissue plasminogen activator or urokinase, or both. Angiography of the infarct-related artery 90 minutes after initiation of thrombolytic therapy demonstrated TIMI grades 0, 1, 2, or 3 flow in 20%, 7%, 17%, and 55% of vessels, respectively. Rescue or adjunctive coronary angioplasty was performed in 80%, 27%, and 16% of patients with TIMI 0/1, 2, or 3 flow, respectively. Predischarge angiography was performed in 963 patients. A significant gradient of increasing mortality was seen in patients with lower TIMI flow (4.3%, 6.1%, and 10.1% with TIMI 3, 2, and 0/1 flow, respectively, p = 0.002). The incidence of congestive heart failure and recurrent ischemia was significantly higher in patients with TIMI 2 than with TIMI 3 perfusion (26% vs 19% for heart failure, p = 0.03; 23% vs 17% for recurrent ischemia, p = 0.05). Acute left ventricular ejection fraction and infarct zone regional wall motion were also significantly improved in patients with TIMI 3 than with TIMI 2 flow, with trends toward better improvement in global and regional function in the TIMI 3 group. These findings were not affected by the use of acute coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
A M Lincoff; E J Topol; R M Califf; K N Sigmon; K L Lee; E M Ohman; U Rosenschein; S G Ellis
Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  The American journal of cardiology     Volume:  75     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1995 May 
Date Detail:
Created Date:  1995-06-01     Completed Date:  1995-06-01     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  871-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Angiography
Coronary Artery Bypass
Coronary Circulation / drug effects,  physiology*
Coronary Disease / classification,  physiopathology,  therapy
Female
Heart Failure / etiology
Humans
Male
Middle Aged
Myocardial Infarction / complications,  physiopathology,  therapy*
Prospective Studies
Recurrence
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use
Urokinase-Type Plasminogen Activator / therapeutic use
Vascular Patency / drug effects,  physiology*
Ventricular Function, Left
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator; EC 3.4.21.73/Urokinase-Type Plasminogen Activator

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


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