Association of initial Thrombolysis in Myocardial Infarction flow grade with mortality among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A National Registry of Myocardial Infarction-5 (NRMI-5) analysis

• Published in: The American heart journal 2011-07, Vol.162 (1), p.178-183
• Main Authors: Wu, Jinhui, MD, Pride, Yuri B., MD, Frederick, Paul D., MPH, MBA, Gibson, C. Michael, MS, MD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; China - epidemiology; Clinical outcomes; Coronary Circulation; Coronary heart disease; Coronary Thrombosis - epidemiology; Coronary Thrombosis - etiology; Coronary Thrombosis - therapy; Coronary vessels; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Hospital Mortality - trends; Humans; Incidence; Male; Medical sciences; Mortality; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Registries; Retrospective Studies; Risk Factors; Survival Rate - trends; Time Factors; United States - epidemiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2011.03.018

Background Initial epicardial coronary flow, as assessed by the Thrombolysis in Myocardial Infarction flow grade (TFG), prior to primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) has been associated with short- and long-term mortality in randomized clinical trials. This study was designed to determine the relationship between initial TFG and mortality in a large, heterogeneous, real-world population of STEMI patients undergoing pPCI. Methods The relationship between pre-pPCI TFG among patients undergoing pPCI and in-hospital mortality was evaluated among STEMI patients from 2004 to 2006 in the National Registry of Myocardial Infarction. Results Of 8,337 STEMI patients, 6,595 (79.1%) had pre-pPCI TFG 0/1, 1,126 (13.5%) had pre-pPCI TFG 2, and 616 (7.4%) had pre-pPCI TFG 3. TFG 0/1 prior to pPCI was associated with 3.4% in-hospital mortality, whereas TFG 2 (2.0%) and TFG 3 (1.8%) were associated with significantly lower mortality (TFG 0/1 vs TFG 2, P = .013; TFG 0/1 vs TFG 3, P = .035). TFG 0/1 prior to pPCI was also associated with a significant increase in the composite of death, recurrent myocardial infarction, heart failure, and shock (16.1%) when compared with patients presenting with TFG 2 (11.5%; P < .001) and TFG 3 (7.6%; P < .001). The difference in this composite was also significant between patients presenting with TFG 2 and TFG 3 ( P = .01). Conclusions In a large, heterogeneous group of real-world patients presenting with STEMI, pre-pPCI TFG 0/1 is associated with higher in-hospital mortality and other major adverse cardiovascular events. These results corroborate prior to post hoc analyses from randomized clinical trials and support continued efforts aimed at safely establishing early infarct-related artery patency among patients with STEMI.