Nine of 11 clinical events (unstable angina and coronary artery bypass graft surgery) occurred in patients with low coronary flow velocity.ĭetermination of flow velocity after reperfusion may enhance patient characterization and provide the physiological rationale for clinical variations after reperfusion therapy. 02) for TIMI grade 3, there was a large overlap with TIMI grades < or = 2 that had low flow velocity (< 20 cm/s). Although post-PTCA flow velocity correlated with angiographic cineframes-to-opacification count (r =. In the univariate analysis, duration of chest pain, total ischemic time, inverted T waves in baseline ECG, reduction of chest pain at 90 and 120 minutes, and ST-segment recovery 50 in ECG at 90 minutes were found to be associated with TIMI 3 flow. TIMI grade 3 flow increased to 21.8 +/- 10.9 cm/s (P <. We observed that among 201 patients with STEMI, around 60 had TIMI 3 flow following thrombolysis. Poststenotic flow velocity increased from 6.6 +/- 6.1 to 20.0 +/- 11.1 cm/s (P <. After PTCA, 1 patient had TIMI grade 1, 5 had TIMI 2, and 35 had TIMI 3 flow. Flow velocity was similar among patients with TIMI grades 0, 1, or 2 but was lower than in those with TIMI grade 3 flow (9.4 +/- 5.4 versus 16.0 +/- 5.4 cm/s for TIMI grades < or = 2 versus TIMI grade 3, respectively P <. Before PTCA, 34 patients had TIMI grade 0 or 1, 5 had TIMI grade 2, and 2 had TIMI grade 3 flow in the infarct artery. However, intracoronary blood flow velocity has not been compared with the angiographic method of determining flow grade in patients.Ĭoronary flow velocity (measured by use of a Doppler guidewire) during primary or rescue PTCA in 41 acute myocardial infarction patients was compared with TIMI grade and cineframes-to-opacification count. Different TIMI angiographic flow grades (flow grades based on results of the Thrombolysis in Myocardial Infarction trial) have been associated with different clinical results after reperfusion for acute myocardial infarction. In conclusion, we found that an increase in corrected TIMI frame count following successful IRA opening in AMI is an early angiographic indicator of coronary microvascular injury.This study compared angiographically graded coronary blood flow with intracoronary Doppler flow velocity in patients during percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction. In the early phase of reperfusion (between and ), TIMI flow deteriorated by >/=1 point in 19 (7.3%) patients despite angiographic optimisation of the PCI result. TIMI-3 flow was achieved in 236 (90.8%) patients at. Coronary flow deterioration (cTFC(DET)) was defined as the difference between cTFC(O15) and cTFC(O). No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75). A mean of 333 ± 123 mcg of intracoronary epinephrine was administered. Microvascular injury was assessed by indexes STi(O15)=sigmaST(O15)/sigmaST(B), STi(C24)=sigmaST(C24)/sigmaST(B), and by peak CK-MB release. TFG, TIMI frame count (TFC), and TIMI myocardial perfusion grade (TMPG) were recorded before and after intracoronary epinephrine administration. The sum of ST-segment elevation in standard ECG leads (sigmaST) was measured at, at and 24 h after. In 272 consecutive patients (age 56.9+/-10.4 years) with AMI treated by primary angioplasty (PCI), coronary blood flow (Trombolysis in Myocardial Infarction (TIMI) scale and corrected TIMI frame count (cTFC)) was evaluated before, immediately after and 15 min after opening of the IRA. We hypothesised that deterioration of epicardial blood flow in early reperfusion may identify early signs of coronary microvascular injury. In a significant proportion of patients with acute myocardial infarction (AMI), successful opening of the infarct related artery (IRA) does not translate into adequate perfusion at the tissue level.
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