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Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis In
C M Gibson1, S A Murphy, M J Rizzo
1Cardiovascular Division of the Department of Medicine, the Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Insights
The corrected TIMI frame count (CTFC) predicts patient outcomes after thrombolytic therapy. Lower CTFC values indicate faster coronary blood flow and are associated with better in-hospital and 1-month survival rates.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Trials
Background:
- The corrected TIMI frame count (CTFC) quantifies coronary blood flow objectively.
- It measures the number of cine frames for dye to reach distal coronary landmarks.
Purpose of the Study:
- To examine the relationship between CTFC and clinical outcomes in patients undergoing thrombolytic therapy.
- To determine if CTFC is an independent predictor of mortality.
Main Methods:
- CTFC was measured in 1248 patients across TIMI 4, 10A, and 10B trials.
- Statistical analyses, including multivariate modeling, were used to assess CTFC's predictive value for mortality.
- Patients were stratified based on CTFC values to evaluate risk subgroups.
Main Results:
- Higher CTFC (slower flow) was significantly associated with increased in-hospital and 30-day mortality.
- The 90-minute CTFC independently predicted in-hospital mortality, even after adjusting for other risk factors.
- A subgroup of patients with TIMI grade 3 flow and faster CTFC (<40 frames) showed a particularly low risk of adverse outcomes.
Conclusions:
- Faster 90-minute CTFCs correlate with improved clinical outcomes post-thrombolysis.
- CTFC can identify lower- and higher-risk subgroups even within the normal TIMI grade 3 flow classification.
Background:
The corrected TIMI frame count (CTFC) is the number of cine frames required for dye to first reach standardized distal coronary landmarks, and it is an objective and quantitative index of coronary blood flow.
Methods And Results:
The CTFC was measured in 1248 patients in the TIMI 4, 10A, and 10B trials, and its relationship to clinical outcomes was examined. Patients who died in the hospital had a higher CTFC (ie, slower flow) than survivors (69. 6+/-35.4 [n=53] versus 49.5+/-32.3 [n=1195]; P=0.0003). Likewise, patients who died by 30 to 42 days had higher CTFCs than survivors (66.2+/-36.4 [n=57] versus 49.9+/-32.1 [n=1059]; P=0.006). In a multivariate model that excluded TIMI flow grades, the 90-minute CTFC was an independent predictor of in-hospital mortality (OR=1.21 per 10-frame rise [95% CI, 1.1 to 1.3], an approximately 0.7% increase in absolute mortality for every 10-frame rise; P<0.001) even when other significant correlates of mortality (age, heart rate, anterior myocardial infarction, and female sex) were adjusted for in the model. The CTFC identified a subgroup of patients with TIMI grade 3 flow who were at a particularly low risk of adverse outcomes. The risk of in-hospital mortality increased in a stepwise fashion from 0.0% (n=41) in patients with a 90-minute CTFC that was faster than the 95% CI for normal flow (0 to 13 frames, hyperemia, TIMI grade 4 flow), to 2.7% (n=18 of 658 patients) in patients with a CTFC of 14 to 40 (a CTFC of 40 has previously been identified as the cutpoint for distinguishing TIMI grade 3 flow), to 6.4% (35/549) in patients with a CTFC >40 (P=0.003). Although the risk of death, recurrent myocardial infarction, shock, congestive heart failure, or left ventricular ejection fraction 20 to
Conclusions:
Faster (lower) 90-minute CTFCs are related to improved in-hospital and 1-month clinical outcomes after thrombolytic administration in both univariate and multivariate models. Even among those patients classified as having normal flow (TIMI grade 3 flow, CTFC
