This intervention re-establishes a certain degree of antegrade coronary flow to the extent that the exposed underlying thrombus can undergo restratification into either a small thrombus burden (grade 1–3) or a large thrombus burden (grade 4) with treatment ensuing accordingly (Figure 2). Their method utilizes either a guide wire or a 1.5 mm balloon for crossing and recanalization of the target thrombus. Focusing on this specific grade, they added a much needed critical step to the reclassification that significantly improves the determination of the correct load of the underlying thrombus ( Box 2). Thus, in order to overcome the abovementioned limitation of TIMI grade 5, an important modification was recently introduced by the Thoraxcenter (Rotterdam, The Netherlands) investigators. Notably, such assumptions may be erroneous and, in fact, lead to faulty decisions concerning the potential of percutaneous revascularization to open the occluded vessel. Consequently, the histological relationship between the underlying plaque burden and thrombus content is unknown, yet this grade supposedly represents the highest thrombus load. With its hallmark characteristic of TIMI 0 flow, the ischemic vessel containing grade 5 thrombus is totally occluded. doi: 10.1253/circj.71.862.While this classification is user friendly and universally accepted, the accuracy of the highest level, grade 5, is subject to interpretation challenges. Effects of the early administration of heparin in patients with ST-elevation myocardial infarction treated by primary angioplasty. doi: 10.1016/j.ahj.2007.08.027.Ĭhung WY, Han MJ, Cho YS, Kim KI, Chang HJ, Youn TJ, Chae IH, Choi DJ, Kim CH, Oh BH, Park YB, Choi YS. Guideline adjudicated fibrinolytic failure: incidence, findings, and management in a contemporary clinical trial. Lancet 8 361(9360):847–858īuller CE, Welsh RC, Westerhout CM, Webb JG, O’Neill B, Gallo R, Armstrong PW. doi: 10.1016/j.jacc.2007.04.084.īoersma E, Mercado N, Poldermans D, Gardien M, Vos J, Simoons ML (2003) Acute myocardial infarction. Reperfusion strategies in acute ST-segment elevation myocardial infarction: a comprehensive review of contemporary management options. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J Am Coll Cardiol. Post-interventional TIMI flow < or = 2 is strongly associated with adverse out-come during hospitalization and after 6 months following hospitalization.Īntman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Ornato JP. After 6 months, patients without restored normal TIMI flow had worse New York Heart Association functional class (NYHA), and had to undergo repeat coronary angiography more often. A regressions analysis showed that predictors leading to such flow patterns are diabetes (P = 0.013), pre-hospital fibrinolytic therapy (P = 0.017), cardiogenic shock (P = 0.002) and a 3-vessel disease (P = 0.003). In patients with post-interventional TIMI flow < or = 2 the left anterior descending coronary artery (LAD) was significantly more often seen as the target vessel (54.3% Vs. 11.4% P = 0.045) compared to patients with TIMI flow < or = 2. 24.3% P = 0.002) and use of intra-aortic balloon pump were all more unlikely (5.8% Vs. 44.2% P < 0.0001), and prehospital fibrinolytic therapy (6.3% Vs. 32.9% P < 0.0001), left ventricular ejection fraction was better (51.3 Vs. In this group, in-hospital mortality was significant lower (6.4% Vs. In 430 patients, post-interventional TIMI flow 3 could be established. We retrospectively evaluated data from our single center "real world patients" database of patients undergoing primary PCI to determine differences in clinical and angiographic patterns in patients with or without restoring thrombolysis in myocardial infarction (TIMI) flow 3.īetween 20, 500 patients underwent primary PCI for STEMI. Growing evidence suggests that poor coronary blood flow after primary percutaneous coronary intervention (PCI) is associated with unfavorable clinical out-come.
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