Circulation, Vol 87, 1829-1839, Copyright © 1993 by American Heart Association
JL Anderson, LA Karagounis, LC Becker, SG Sorensen and RL Menlove
BACKGROUND. Coronary patency has been used as a measure of thrombolysis
success after acute myocardial infarction. The Thrombolysis in Myocardial
Infarction (TIMI) Study Group perfusion grades have gained wide acceptance,
with grades 0 (no distal flow) and 1 perfusion (minimal flow) being
designated as thrombolysis failures and grades 2 (partial perfusion) and 3
(complete perfusion) as thrombolysis successes. However, the significance
of the individual TIMI grades on clinical outcome has not been adequately
assessed. METHODS AND RESULTS. To evaluate the functional significance of
TIMI perfusion grades, we compared 1-day coronary patency status with
ventriculographic, enzymatic, and ECG indexes of acute myocardial
infarction in 298 patients treated with anistreplase or alteplase within 4
hours of myocardial infarction symptom onset. Radionuclide ejection
fraction was determined at 1 week and at 1 month. Perfusion grades for the
entire study population were distributed as 12% (n = 37) grades 0/1, 13% (n
= 40) grade 2, and 74% (n = 221) grade 3. Patency profile did not differ
between the two thrombolytic regimens. Further coronary interventions were
performed after the 1-day patency determination in 43% of patients (43%,
48%, 42%, respectively, in grades 0/1, 2, and 3 patients). The outcome of
grade 2 patients did not differ from grades 0/1 patients in ejection
fraction, enzyme peaks, ECG markers, or morbidity index. In contrast, grade
3 patients, compared with grades 0-2 patients, showed 1) a greater global
ejection fraction at 1 week (54% versus 49%, p = 0.006) and at 1 month (54%
versus 49%, p = 0.01), 2) a greater infarct zone ejection fraction at 1
week (41% versus 33%, p = 0.003) and at 1 month (42% versus 32%, p =
0.003), 3) smaller enzyme peaks, significant for lactate dehydrogenase, and
shorter times to enzyme peaks, significant for all four enzymes, 4) a
smaller QRS score at discharge and at 1 month, and 5) a trend toward a
lower morbidity index. CONCLUSIONS. Grade 3 flow predicts significantly
better outcomes than lesser grades of flow and represents an important
measure of reperfusion success.
ARTICLES
TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction. Ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 Study
Division of Cardiology, University of Utah, LDS Hospital, Salt Lake City, UT 84143.
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