Temporal trends in the pre-procedural TIMI flow grade among patients with ST- segment elevation myocardial infarction
Nili Schamroth Pravda1,2, Tal Cohen3, Robert Klempfner3
1Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) and TIMI flow grade 0 still face worse outcomes. However, in-hospital complications have decreased over time for these patients, though mortality rates remain unchanged.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Pre-procedural Thrombolysis In Myocardial Infarction (TIMI) coronary flow grade is a known predictor of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients.
- Advances in pharmacologic and invasive treatments for STEMI have occurred.
- Temporal trends in clinical outcomes based on TIMI flow grade in STEMI patients require assessment.
Purpose of the Study:
- To evaluate temporal trends in clinical outcomes for STEMI patients stratified by pre-procedural TIMI coronary flow grade.
- To compare outcomes between STEMI patients with TIMI flow grade 0 versus TIMI flow grades 1-3 over time.
Main Methods:
- Analysis of STEMI patient data from the Acute Coronary Syndrome Israeli Survey (ACSIS) registry.
- Time-dependent analysis comparing early (2008-2010) and late (2013-2018) periods.
- Outcomes assessed included in-hospital complications, 30-day Major Adverse Cardiovascular Events (MACE), and 1-year mortality.
Main Results:
- A total of 2453 STEMI patients were included.
- Pre-procedural TIMI flow grade 0 remained prevalent (approx. 58.7%) in both early and late periods.
- In-hospital complications decreased significantly for TIMI flow grade 0 patients (36.1% to 26.8%, P < 0.001), but not for TIMI flow grades 1-3.
- TIMI flow grade 0 was associated with worse 30-day MACE and 1-year mortality compared to TIMI flow grades 1-3.
- No temporal changes were observed in 30-day MACE or 1-year mortality for either group.
Conclusions:
- Pre-procedural TIMI flow grade 0 remains common in STEMI patients and is linked to poorer prognosis.
- While in-hospital complications have improved for STEMI patients with TIMI flow grade 0, 30-day MACE and 1-year mortality have not changed over time.
- Continued focus on improving reperfusion strategies and secondary prevention in STEMI patients with poor initial flow is warranted.
Background:
Pre-procedural TIMI coronary flow grade in patients with ST segment elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. There have been great advances in pharmacologic and invasive treatment of STEMI patients in the current era. We aimed to assess the temporal trends in clinical outcomes according to the TIMI flow grade amongst these patients.
Methods:
Data of patients with STEMI from the acute coronary syndrome Israeli Survey (ACSIS) registry. A time-dependent analysis stratifying patient by TIMI flow grade 0 and TIMI flow grade 1-3 was performed. Survey years were divided to early (2008-2010) and late period (2013-2018). Clinical outcomes included in-hospital complications, 30d MACE (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.Results and Conclusions: Included were 2453 patients. The majority of patients had pre-procedural TIMI flow 0 (58.9% in the early period and 58.7% in the late period, P = 0.97). In-hospital complications of patients with TIMI flow 0 has significantly decreased over time (36.1% vs 26.8%, P < 0.001) but not amongst patients with TIMI flow 1-3. Compared with TIMI flow 1-3, patients with TIMI flow 0 had worse 30d MACE and 1-year mortality. There was no temporal change of these outcomes in either TIMI flow grade group. TIMI flow grade 0 is still more common among patients with STEMI and is associated with poorer prognosis. Nevertheless, over time, in-hospital complications have decreased among patients with TIMI 0, while 30d MACE and 1-year mortality has remained unchanged.
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