Abstract 12823: The Prognostic Impact of Pre-procedural Thrombolysis in Myocardial Infarction Flow Grade in Acute Myocardial Infarction Patients was Persisted up to Five Year Follow up
Background: There has been few data for the long-term prognostic effect of pre-procedural coronary flow grade in acute myocardial infarction (AMI) patients. The aim of our investigation was to evaluate the impact of pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade on five-year Major Adverse Cardiac Events (MACE).
Methods: 1,142 patients who were enrolled Chonbuk AMI registry (Chonbuk National University hospital, Presbyterian Medical Center, and Wonkwang University, Jeonbuk Province of South Korea) from November 2005 to January 2008 were investigated (follow-up duration 56.7±23.3 months). The inclusion criteria were patients with AMI (confirmed by symptom, electrocardiography and elevated biomarkers) who were undertaken coronary angiography. The study populations were divided into the two groups (group I: TIMI grade flow 0/1 (n=709, 63.9±13.4 years, male 67.7%), group II: TIMI flow grade 2/3 (n=433, 64.1±11.9years, male 69.1%)). MACE was defined as cardiac death, recurrent myocardial infarction, and target vessel revascularization (TVR).
Results: There were no statistical differences in baseline clinical and laboratory characteristics except the proportion of ST-elevation MI (STEMI) (group I: n=477 (67.3%) vs group II: n=197 (45.5%), p≤0.001), infarct-related right coronary artery (n=278 (39.2%) vs n=117 (27.0%), p≤0.001)), type B2/C complex lesion (n=512 (72.3%) vs n=250 (57.8%), p≤0.001), the proportion of post-procedural TIMI grade 3 flow (n=641 (90.5%) vs n=422 (97.5%), p≤0.001) and pre-discharge ejection fraction (51.8±11.6 % vs 54.5±10.9 %, p≤0.001). One, two and five-year MACE were significantly different between the two group [1-year (10.7% vs 5.5%, p=0.002), 2-year (12.8% vs 6.6%, p=0.001), and 5-year (16.6% vs 11.0%, p=0.007)]. Multivariate regression analysis showed that significant independent predictors for five-year MACE were low pre-procedural TIMI flow grade (HR=1.59, p=0.006), age (>70 years) (HR= 1.52, p=0.010), Killips classification (3/4, HR= 1.76, p=0.011), STEMI (HR= 1.37, p=0.040).
Conclusion: One and two-year higher MACE in lower TIMI grade AMI patients was persisted up to five-year clinical follow-up. Future larger long-term follow up study are needed to clarify our results.
- © 2013 by American Heart Association, Inc.