Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES The purpose of this study was to determine the clinical and angiographic correlates and outcomes of patients with suboptimal coronary flow after primary percutaneous coronary interventions (PCI). BACKGROUND The clinical and angiographic correlates and outcomes of Thrombolysis in Myocardial Infarction (TIMI) less than or equal to2 flow in patients treated with primary PCI are not known. METHODS We evaluated 3,362 patients with ST elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction trials, who underwent primary PCI. RESULTS Post-procedural final TIMI less than or equal to2 flow occurred in 232 (6.9%) patients. Multivariate analysis identified age, greater than or equal to70 years (odds ratio [OR], 1.6; 45% confidence interval [CI], 1.1 to 2.2), diabetes (OR 1.9; 954 CI, 1.3 to 2.7), symptom onset to emergency room presentation (OR 1.1; 95% CI, 1.1 to 1.2); initial TIMI less than or equal to1 flow (OR 3.2; 95% CI, 1.9 to 5.5), and left ventricular ejection fraction <50% (OR 1.7; 95% CI, 1.2 to 2.4) as independent correlates of final TIMI : 2 flow. In-hospital (composite of reinfarction, ischemic target vessel revascularization, or death, as well as these events individually) and one-year (reinfarction and/or death) events occurred more frequently in patients with TIMI less than or equal to2 flow. The Cox proportional hazards model identified TIMI less than or equal to2 flow to be independently associated with one-year mortality (hazard ratio 3.8, 95% CI, 2.5 to 5.7). CONCLUSIONS Final TIMI less than or equal to2 flow, although uncommon after primary PCI, was strongly associated with hospital and one-year adverse events. The clustering of final TIMI less than or equal to2 flow in high-risk groups may partially explain the poor prognosis of these patients. Awareness of these risk factors may be useful to, clinicians to triage and treat patients undergoing primary PCI. (C) 2003 by the American College of Cardiology Foundation.