Abstract 20882: Predictors of Suboptimal TIMI Flow after Primary Angioplasty for Acute Myocardial Infarction: Results from the HORIZONS-AMI Trial
Introduction: Not achieving TIMI 3 flow after primary PCI in ST-segment elevation myocardial infarction (STEMI) is strongly related to mortality. The predictors of TIMI flow <3 after PCI in patients with AMI have not been examined in a contemporary, large-scale multicenter prospective study.
Methods: The HORIZONS-AMI trial randomized 3,602 pts with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. UFH+GPI (n=1,802), with a second 3:1 randomization in 3,006 stent eligible pts to the Taxus stent (N=2,257) vs. the bare metal Express stent (N=749). An independent angiographic laboratory assessed all angiograms for baseline and final lesion and flow characteristics. Independent predictors of final TIMI flow <3 were identified using stepwise logistic regression from 36 baseline clinical and angiographic variables.
Results: A total of 3,276 treated lesions were analyzed by the core lab; 2,759 pts (87.2%) had final TIMI 3, 406 (12.8%) had TIMI <3. The independent predictors of TIMI flow <3 are shown in the Table. The 1-year mortality of pts in whom final TIMI 3 flow was vs. was not achieved was 2.9% vs. 8.4%, p<0.0001.
Conclusions: In this large-scale contemporary multicenter prospective randomized trial, non restoration of normal TIMI flow after primary PCI in STEMI occurred in 12.8% of pts, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0–1 flow and lesion length). Not achieving TIMI-3 flow continues to be a powerful predictor of mortality after primary PCI.
- © 2010 by American Heart Association, Inc.