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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction
Takuya Hashimoto1,2, Junya Ako1,2, Koichi Nakao3
1Kitasato University Graduate School of Medical Sciences.
Insights
Pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 in ST-elevation myocardial infarction (STEMI) patients is linked to better outcomes. This includes successful procedures, reduced infarct size, fewer arrhythmias, and lower in-hospital mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Infarct-related artery (IRA) patency before primary percutaneous coronary intervention impacts procedural success, left ventricular function, and mortality.
- Factors influencing pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow require further investigation.
Purpose of the Study:
- To investigate factors associated with pre-procedural TIMI flow in patients with acute myocardial infarction.
- To evaluate the relationship between pre-procedural TIMI flow and clinical outcomes in STEMI patients.
Main Methods:
- Prospective multicenter registry (J-MINUET) including 3,283 consecutive acute myocardial infarction patients.
- Analysis of 2,182 STEMI patients undergoing emergent or urgent coronary angiography.
- Assessment of pre-procedural TIMI flow and its correlation with procedural success, infarct size, arrhythmias, and mortality.
Main Results:
- Pre-procedural TIMI flow grade 3 was significantly associated with post-procedural TIMI flow grade 3 (P < 0.001).
- Higher pre-procedural TIMI flow correlated with lower enzymatic infarct size (P < 0.001), reduced ventricular tachycardia/fibrillation (P = 0.049), and decreased in-hospital mortality (P = 0.020).
- Antiplatelet drug use on admission was associated with improved pre-procedural TIMI flow.
Conclusions:
- Pre-procedural IRA patency, indicated by TIMI flow, is crucial for STEMI management.
- Achieving TIMI flow grade 3 before intervention is linked to favorable procedural and clinical outcomes.
- Antiplatelet therapy may play a role in improving pre-procedural IRA patency.
Abstract:
It has been shown that the patency of an infarct-related artery (IRA) before primary percutaneous coronary intervention determines post-procedural success, better preservation of left ventricular function, and lower in-hospital mortality. However, the factors associated with pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow have not been fully investigated.The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective multicenter registry conducted at 28 Japanese medical institutions between July 2012 and March 2014. We enrolled 3,283 consecutive patients with acute myocardial infarction who were admitted to a participating institution within 48 hours of symptom onset. There were 2,262 patients (68.9%) with ST-elevation myocardial infarction (STEMI), among whom 2,182 patients underwent emergent or urgent coronary angiography.Pre-procedural TIMI flow grade 3 was related to post-procedural TIMI flow grade 3 (P < 0.001), lower enzymatic infarct size (P < 0.001), lower ventricular tachycardia and ventricular fibrillation (P = 0.049), and lower in-hospital mortality (P = 0.020). A history of antiplatelet drug use was associated with pre-procedural TIMI flow.Antiplatelet drug use on admission was associated with pre-procedural TIMI flow. The patency of the IRA in patients with STEMI was related to procedural success and decreased enzymatic infarct size, fatal arrhythmic events, and in-hospital mortality.
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