Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty

OBJECTIVES The aim of the study was to evaluate the impact of preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow on one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty. BACKGROUND Although there is an excellent outcome conferred by primary angioplasty in patients with STEMI, the prognostic role of early recanalization in these patients has yet to be investigated. METHODS Our population is composed of 1,791 patients with acute myocardial infarction treated by primary angioplasty at our institution from 1994 to 2001. All angiographic, clinical, and follow-up data were prospectively collected. According to the TIMI risk score, patients were stratified in low- and high-risk groups. RESULTS Preprocedural TIMI flow was related to postprocedural TIMI flow grade 3 (p = 0.002), myocardial blush grade 2 to 3 (p < 0.001), enzymatic infarct size (p < 0.001), predischarge ejection fraction (p < 0.001), and one-year mortality (p < 0.05). Multivariate analysis showed that preprocedural TIMI flow grade 3 was an independent predictor of one-year survival in high-risk patients (p < 0.05). CONCLUSIONS This study shows that preprocedural TIMI flow grade 3 is an independent predictor of one-year survival in high-risk patients with acute myocardial infarction treated by primary angioplasty. These data suggest that all efforts should be made to obtain early and optimal restoration of antegrade flow, particularly in high-risk patients and when transportation to tertiary centers, with a conceivable further time delay, is required. (C) 2004 by the American College of Cardiology Foundation