Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3.
However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40+/-10 vs 20+/-6 cm/s, P<0.0001).
The diagnosis of TIMI 3 based on diastolic peak distal LAD flow velocity > or =25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively.
In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29+/-12 minutes later.
Age and a history of myocardial infarction were added into the multivariate model, and a risk score was developed to predict the likelihood of failure to achieve TIMI-3 flow.
On multivariate analysis, the factors associated with failure to achieve TIMI-3 flow were ST recovery of <70% (P =.009), a 60-minute/baseline troponin T ratio of < or =5 (P =.0004), a baseline CK-MB level of >4 microg/L (P =.039), or a baseline myoglobin level of >85 microg/L (P =.048).
A score of < or =2 excluded failure to achieve TIMI-3 flow with 96% accuracy, and a score of > or =7 predicted failure to achieve TIMI-3 flow with 90% accuracy.
Failure to achieve TIMI-3 flow in the infarct-related artery within 90 minutes after the start of fibrinolysis can be accurately predicted at approximately 60 minutes by a score incorporating clinical variables, ST recovery, and the 60-minute/baseline ratios of troponin T, CK-MB, and/or myoglobin levels.
Post-interventional TIMI flow ≤ 2 is strongly associated with adverse out-come during hospitalization and after 6 months following hospitalization.
There was also a trend towards a longer period of chest pain in patients with post-interventional TIMI flow ≤ 2.
The post-interventional TIMI flow is an important prognostic value for in-hospital mortality and clinical outcome 6 months post-hospitalization [].
A finding that has not been previously described is that patients undergoing rescue PCI due to inefficient intravenous fibrinolytic therapy have a post-interventional TIMI flow ≤ 2 significantly more often.
On multivariate analysis, diabetes (OR [odds ratio] 5.56; P = .0007), smoking (OR 3.56; P = .034), and prior transplant (OR 2.81; P = .047) were associated with early ACS.
Thirty-seven percent of early ACS occurred perioperatively, the majority in the first 3 posttransplant months.
This observational case-controlled study included 780 patients who underwent a kidney transplant between 1989 and 2001 who experienced early ACS (within 2 years).
The TIMI score provided modest prognostic discrimination and calibration among elderly patients with STEMI.
Thirty-day mortality rates were higher among patients with higher TIMI scores (TIMI score 2: 4.4% vs TIMI score >8: 35.6%, P < .0001 for trend).
Thirty-day mortality rates in the cohort were higher than published TIMI estimates (P = .001; eg, TIMI score 2: 4.4% cohort vs 2.2% published rate).
Mortality rates for TIMI scores differed between patients who did and did not receive reperfusion therapy (P < .0001 for TIMI score × reperfusion therapy interaction).
TIMI-derived volume flow was not statistically significantly different between graft types, perhaps reflecting the similar target territory (LCx coronary artery) and distal run-offs, but were comparable to those measured previously using intra-operative volume flowmetry .
TIMI analysis was conducted by independent investigators.
Flow characteristics in both grafts were assessed using the TIMI frame count.
In addition, two further inflammatory markers [monocyte chemoattractant protein-1 (MCP-1) and von Willebrand factor (vWF)] were assessed in OPUS-TIMI 16.
Directionally, similar findings were observed for MCP-1 and vWF in OPUS-TIMI 16 and for C-reactive protein in TACTICS-TIMI 18.
Diabetic patients had higher C-reactive protein and MCP-1 levels vs. non-diabetic patients in OPUS-TIMI 16 (9 vs. 7.8 mg/L, P = 0.002, and 190.6 vs. 170.8 pg/mL, P = 0.04, respectively), higher C-reactive protein levels in TACTICS-TIMI 18 (6.6 vs. 5.2 mg/L, P = 0.0005), and as expected higher glucose levels in both trials.
Secondary end points include: - Angiographic end points: post-procedural TIMI flow, MBG (by visual estimation and with the QuBE program) and angiographically visible distal embolization - Electrocardiographic end points: residual ST-segment deviation 30 to 60 minutes after the procedure - Enzymatic infarct size - Mortality and Major Adverse Cardiac Events (MACE, a combined end point of target vessel revascularization, reinfarction, and cardiovascular mortality) at 30 days and 1 year.
TIMI 3 flow was achieved after 20 min with 200,000 units of urokinese by PST, followed by balloon angioplasty.
TIMI 3 flow was recovered at 20 min with 240,000 units of urokinese and an additional 72,000 units of rt-PA, followed by redilatation with a quarter-size larger balloon than that used in stent deployment.
TIMI Risk Score had good power to predict 30-day (c statistic 0.834, 95% CI 0.757-0.91, p <0.0001) as well as one-year mortality (c statistic 0.809, 95% CI 0.739-0.878, p <0.0001).
TIMI Risk Score accurately defines the population of STEMI patients who are at high risk of death not only during the first 30 days, but also during a long-term follow-up.
Median TIMI risk score was 4 (ranging from 0 to 10).
In multivariate logistic regression analysis TIMI Risk Score was one of the independent risk factors of death during one-year follow-up (OR 1.59, p <0.001).
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