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Corrected TIMI frame counts correlate with stenosis severity and infarct zone wall motion after thrombolytic therapy
D J Amos1, J K French, J Andrews
1Cardiology Department, Green Lane Hospital, Auckland 1030, New Zealand.
Insights
Slowed blood flow in heart arteries after treatment for myocardial infarction correlates with artery narrowing, reduced heart muscle function, and creatine kinase (CK) levels. This highlights the importance of assessing flow for patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Biochemistry
Background:
- Most patients with open infarct-related arteries post-thrombolytic therapy exhibit reduced blood flow, impacting myocardial perfusion.
- Assessing blood flow is crucial for understanding post-myocardial infarction recovery.
Purpose of the Study:
- To investigate the relationship between creatine kinase (CK) levels, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC), infarct artery stenosis, and left ventricular function.
- To determine how these factors correlate in patients recovering from myocardial infarction.
Main Methods:
- Studied 397 patients with a first myocardial infarction, assessing TIMI flow grades, CTFC, infarct artery stenosis, and infarct zone wall motion via contrast ventriculography.
- Measured CK levels hourly for the first 4 hours post-streptokinase, then every 4 hours for 20 hours.
Main Results:
- A correlation was found between infarct artery stenosis and CTFC (r = 0.33, P <.001) in patients with patent arteries.
- CTFC correlated with hypokinetic segments in the infarct zone (r = 0.15, P =.01).
- Higher CTFC values (indicating slower flow) were associated with worse wall motion and higher rates of CK level increase.
Conclusions:
- Prolonged corrected TIMI frame counts are linked to infarct artery stenosis severity.
- Slowed blood flow correlates with impaired infarct zone regional wall motion.
- CTFC also shows a correlation with creatine kinase (CK) levels post-myocardial infarction.
Background:
The majority of patients with patent infarct-related arteries after thrombolytic therapy have slower than normal flow, which relates to myocardial perfusion.
Methods:
To evaluate the relationships between blood levels of creatine kinase (CK) and the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC), infarct artery stenosis, and left ventricular function, we studied 397 patients with a first myocardial infarction who underwent angiography at 3 weeks. TIMI flow grades, the CTFC, infarct artery stenosis, and infarct zone wall motion (by contrast ventriculography using the centerline method) were assessed, and CK levels (in units per liter) were measured hourly for the first 4 hours after streptokinase (1.5 x 10(6) U over 30-60 minutes) and then every 4 hours over the next 20 hours, all blinded to treatment and outcome.
Results:
Infarct artery stenosis and the CTFC, assessed as continuous variables, correlated in patients with patent infarct arteries (r = 0.33, P <.001). Also, there was a significant correlation between the CTFC and the sum of hypokinetic chords in the infarct zone (r = 0.15, P =.01). Patients with total occlusion or markedly slowed infarct artery flow (CTFC >100) had a higher fraction of chords with wall motion >2 SDs below normal (0.65 [0.41, 0.80] vs 0.37 [0.0, 0.67]) compared with patients with normal flow (CTFC < or =27) (P <.001). The rates of increase of median CK levels with respect to TIMI flow grades were 342 U/L/h for TIMI 3 versus 212 U/L/h for TIMI 2 versus 140 U/L/h for TIMI 0-1 (P <.0001).
Conclusions:
Prolonged corrected TIMI frame counts correlate with stenosis severity in the infarct artery after infarction, infarct zone regional wall motion, and CK levels.
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