The Angiographic Fate of Infarct Related Arteries with TIMI 2 Flow Following Thrombolysis for Acute Myocardial Infarction

Abstract

In the GUSTO Angiographic Trial 1,175 patients underwent angiography at a mean of 97 ± 12 min following thrombolysis with either t-PA, Streptokinase, or a combination of both agents. For all treatment groups combined, 313 (27%) patients had TIMI 2 flow (T2). Of the patients with early TIMI 2 flow 151 (48%) continued to have TIMI 2 flow af follow-up (f/u) angiography a mean of 5.9 ± 1.9 days later. while in 162 (52%) the flow had improved to TIMI 3. The plot on the left shows the minimum luminal diameter (MLD) for patients with TIMI 2 flow at 90 minutes and 5–7 day f/u vs those with TIMI 2 flow at 90 minutes and TIMI 3 flow at f/u. The plot on the right shows the percentage of patients with angiographically visible thrombus at 90 minutes and f/u for patients with TIMI 2 flow at 90 minutes and 5–7 day f/u vs those with TIMI 2 flow at 90 minutes and TIMI 3 flow at f/u. Infarct related arteries that improve from TIMI 2 to TIMI 3 during the week following thrombolysis show a significant increase in minimal luminal diameter and decrease in visible thrombus compared with IRA:s that remain TIMI 2 suggesting that yet incomplete clot lysis explains the initial slow flow in this cohort.