![]() 9 In GUSTO I, treatment with t-PA resulted in higher rates of TIMI grade 3 flow at 60 and 90 minutes compared with streptokinase, but by 180 minutes, rates were similar. 4,8 Trials of prehospital thrombolysis, which saved between 30 and 120 minutes, demonstrated a 19% reduction in mortality. The importance of time to achieving reperfusion has also been emphasized by several types of studies, including observational studies of time to treatment versus mortality. 6,7 Thus, an active treatment that increased TIMI grade 3 flow led to improved survival. 6,7 This trial demonstrated that a more aggressive thrombolytic regimen (using tissue plasminogen activator ) that could improve the achievement of early TIMI grade 3 flow could also reduce mortality. The open artery hypothesis became the “open artery theory” 5 after the results of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) I trial. 3,4 There is a nearly linear correlation between higher rates of early TIMI grade 3 flow and improved survival, regardless of whether reperfusion is achieved with thrombolysis or primary percutaneous coronary intervention (PCI). 2 When differentiating apparently normal TIMI grade 3 flow from more delayed TIMI grade 2 flow in patent arteries, greater myocardial salvage and improved survival were observed in patients who achieved TIMI grade 3 flow. 1 After numerous studies confirmed the benefit of a patent infarct-related artery, more careful examination of the degree of reperfusion was performed using the Thrombolysis in Myocardial Infarction (TIMI) flow grading system devised in the TIMI 1 trial. Since the advent of reperfusion therapy for acute ST elevation myocardial infarction, the “open artery hypothesis” proposed that benefit is achieved from early reperfusion of the occluded coronary artery, which limits the size of infarction, reduces the degree of left ventricular dysfunction, and improves survival. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).In this post-hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events. Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. ![]() However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74–4.85). 30) were highest in patients with TIMI flow 0/1. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p <. Results :įrom a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3. The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline‐adherent therapy. Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST‐elevation myocardial infarction (STEMI).
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