To the Editor:
The GUSTO-1 Angiographic Investigators conclude in their paper,1 “Because at early angiography (eg, 90 minutes) one cannot predict the natural evolution of a given infarct-related artery with TIMI grade 2 flow (progression to grade 3 or arrest at grade 2) and because improvement in infarct arterial flow from TIMI grade 2 to 3 is associated with a significant improvement in left ventricular function, our observations suggest that perhaps a strategy of rescue angioplasty for vessels demonstrating early, sluggish flow warrants consideration.” Further additional argument supporting this proposal was provided by the GUSTO Investigators in another article,2 “… the surprising finding that TIMI grade 2 flow was associated with a higher mortality during the first 4 hours [and importantly during the first 24 hours as well] than TIMI grade 0 or 1 flow may indicate that partial reperfusion has a detrimental effect on the myocardium.” Specifically, this is the case in the subgroup of patients characterized by the coincidence of presentation with a short delay after onset of symptoms and critically depressed left ventricular function (ie, patients with an extensive area at risk of ischemia threatening with large potential infarct), who are most likely to benefit from the rescue intervention.
- Copyright © 1998 by American Heart Association
Reiner JS, Lundergan CF, Fung A, Coyne K, Cho S, Israel N, Kazmierski J, Pilcher G, Smith J, Rohrbeck S, Thompson M, Van de Werf F, Ross AM, for the GUSTO-1 Angiographic Investigators. Evolution of early TIMI 2 flow after thrombolysis for acute myocardial infarction. Circulation. 1996;94:2441–2446.
Kleiman NS, White HD, Ohman EM, Ross AM, Woodlief LH, Califf RM, Holmes DR, Bates E, Pfisterer M, Vahanian A, Topol EJ, for the GUSTO Investigators. Mortality within 24 hours of thrombolysis for myocardial infarction: the importance of early reperfusion. Circulation. 1994;90:2658–2665.