Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry

• Published in: Archives of cardiovascular diseases 2018-02, Vol.111 (2), p.101-108
• Main Authors: Bailleul, Clotilde, Aissaoui, Nadia, Cayla, Guillaume, Dillinger, Jean-Guillaume, Jouve, Bernard, Schiele, François, Ferrières, Jean, Simon, Tabassome, Danchin, Nicolas, Puymirat, Etienne
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Aged; Angioplastie coronaire percutanée; Blood Flow Velocity; Cardiology and cardiovascular system; Chi-Square Distribution; Coronary Circulation; Female; Flux coronaire; France; Human health and pathology; Humans; Infarctus du myocarde; Kaplan-Meier Estimate; Life Sciences; Logistic Models; Male; Middle Aged; Multivariate Analysis; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - mortality; Non-ST Elevated Myocardial Infarction - physiopathology; Non-ST Elevated Myocardial Infarction - therapy; Odds Ratio; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Registries; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - physiopathology; ST Elevation Myocardial Infarction - therapy; Thrombolysis in myocardial infarction; Time Factors; Treatment Outcome
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2017.04.004

Thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3 before percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) is associated with improved outcomes. However, no recent data are available on its impact beyond 1 year and/or by type of AMI. To assess the prognostic impact of prePCI TIMI flow at 30 days and 3 years in patients with ST-segment elevation (STEMI) or non-ST-segment elevation (NSTEMI) AMI. We compared long-term outcomes associated with TIMI flow grade 2/3 versus 0/1 in patients referred for PCI in the nationwide French registry of acute ST-segment elevation or non-ST-segment elevation myocardial infarction (FAST-MI) 2010. TIMI flow grade 2/3 was found in 41% of patients with STEMI and 69% of patients with NSTEMI; it was associated with a lower risk of 30-day death in patients with STEMI (odds ratio 0.30, 95% confidence interval [CI] 0.12–0.77; P=0.01), but not in patients with NSTEMI (odds ratio 0.57, 95% CI 0.22–1.42; P=0.23). TIMI grade flow 2/3 was also associated with a lower risk of 3-year death in patients with STEMI (hazard ratio 0.69, 95% CI 0.49–0.98; P=0.04), but not in patients with NSTEMI (hazard ratio 0.79, 95% CI 0.56–1.11; P=0.17). TIMI flow grade 2/3 is observed more often in patients with NSTEMI; it is an independent predictor of early and late survival in patients with STEMI, but is not significantly related to early or long-term survival in patients with NSTEMI. Le flux intracoronaire (TIMI) 2 ou 3 avant une angioplastie chez les patients pris en charge pour un infarctus du myocarde (IDM) est associé à un meilleur pronostic. Cependant, il n’existe pas de donnée récente après un an de suivi et selon le type d’IDM. Évaluer l’impact pronostic du flux TIMI avant angioplastie à 30jours et à 3 ans chez les patients présentant un IDM avec ou sans sus-décalage ST. Comparaison du devenir clinique à long terme selon le flux TIMI avant angioplastie (2/3 versus 0/1) chez les patients hospitalisés pour un IDM en utilisant les données du registre FAST-MI 2010. Le flux TIMI 2/3 est observé chez 41 % des IDM avec sus-décalage et 63 % des IDM sans sus-décalage. Il est associé à une mortalité plus faible à 30jours dans la population des IDM avec sus-décalage (OR 0,30, IC 95 % 0,12–0,77 ; p=0,01) mais pas dans la population des IDM sans sus-décalage (OR 0,57, IC 95 % 0,22–1,42 ; p=0,23). Le flux TIMI 2/3 est également associé à une mortalité plus faible à 3 ans dans la population des IDM avec sus-décalage (HR 0,