Original title: Predicitors of suboptimal TIMI flow alter primary angioplasty for acute myocardial infarction: results from the HORIZON-AMI trial. Reference: Adriano Caixeta et al.  Eurointervention 2013;9:220-227

Primary angioplasty showed greater efficacy than thrombolytics but one out of every four patients cannot achieve TIMI 3 flow.

The Horizons-AMI trial randomized 3,602 patients to receive bivalirudin or heparin plus inhibitors IIb IIIa and after angiography a second randomization took place to DES or a conventional stent. The primary objective of this analysis was to evaluate the angiographic predictors of both clinical and suboptimal procedural flow (TIMI <3) after stent implantation. The secondary objective was the impact after three years of suboptimal flow, (TIMI 0-2 versus TIMI 3). Angioplasty was performed in 3,345 patients, (92.9%), of which 2,758, (87.1%), had final TIMI 3 flow.

Those who had TIMI

After 30 days and three years, end TIMI flow

Conclusion:

In this large study the lack of restoration of TIMI 3 flow was associated with older age, past infarction, TIMI flow 0-1, lesion length and was a strong predictor of mortality.

Commentary:

This study shows that the failure to achieve TIMI 3 is associated with higher mortality at three years, than the PAMI, Cadillac and Apex IMA studies had shown at six months. It may be important to have a good pre-hospital service where trained personnel are available to bypass the emergency department and refer the patient directly to the catheterization laboratory. 

Courtesy of Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation.
Buenos Aires, Argentina.

Dr. Carlos Fava para SOLACI.ORG