Angiographic TIMI Flow Research Articles

CHA2DS2 - Vasc Score Predict No Reflow Phenomenon in Primary Percutaneous Coronary Intervention

Purpose: ST-Elevation Myocardial Infarction is the most acute manifestation of Coronary artery disease, with substantial morbidity and mortality. Early reperfusion (re-establishing the blood flow in the occluded artery) is the most effective way to preserve the viability of the ischaemic myocardium and limit infarct size. Early diagnosis of STEMI is crucial to initiate appropriate treatment and should ideally be made within 10 minutes of first medical contact. This study aimed to evaluate the CHA2DS2-VASc score as a simple tool for predicting the no-reflow among patients with STEMI who underwent primary percutaneous coronary intervention.
 Methodology: This was a case-control study which was conducted on 100 patients, diagnosed with acute STEMI and underwent primary PCI, who was admitted to Cardiology Department, Benha University Hospital and National Heart Institute. Patients were classified into two groups, control and no-flow, according to their final angiographic TIMI flow rates resulting from primary PCI. The control group: 78 patients with TIMI flow rate >2. The no-reflow group: 22 patients with TIMI flow rate ≤2, despite mechanical reopening of the infarct-related artery in patients without dissection of the coronary artery.
 Findings: In this study, LVEF was significantly lower in patients with no-reflow compared to patients with normal TIMI flow (p <0.001), but LVEDV was significantly higher (p =0.01). There was no significant difference in LVESV between patients with no-reflow compared to patients with normal TIMI flow. CHA2DS2VASC score was significantly higher in patients with no-reflow compared to patients with normal TIMI flow (p <0.001). CHA2DS2VASC score is a significant predictor of occurrence of no reflow phenomenon (AUC: 0.689, p =0.006). At a cut off value of ≥ 2it has a sensitivity of 68.2%, specificity of 58.9%, PPV of 31.9% and NPV of 86.8%.
 Recommendation: The study suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing primary PCI. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before primary PCI interventions in patients with STEMI. Thus we recommend using CHA2DS2-VASc score as it is very simple and a quick tool to predict no-reflow before primary PCI

Correlation of the coronary flow reserve, the angiographic TIMI flow and the contractile reserve in patients with cardiac syndrome x

Correlation of the coronary flow reserve, the angiographic TIMI flow and the contractile reserve in patients with cardiac syndrome x

The Relation between Platelet to Lymphocyte Ratio with Severity And Complexity of Coronary Heart Disease in Patients with Acute ST- Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

AbstractBackground: Coronary Artery Disease (CAD) is charac-terized pathologically by atherosclerosis formation which is the predominant cause of death. The chronic inflammatory response is associated with production of platelets and lym-phocytes, elevated platelet counts accelerate atherosclerosis formation, progression, and destabilization of atherosclerotic plaques. The ratio of absolute number of platelets to the number of lymphocyte (PLR) act as an effective biomarker to predict the severity of CAD.Aim of Study: To study the relation between Platelet to Lymphocyte Ratio (PLR) with severity and complexity of coronary heart disease in patients with acute ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percutaneous Coronary Intervention (PCI).Methods: This study was conducted on 100 patients diagnosed with STEMI and who underwent primary PCI in Tanta University Hospitals, Cardiovascular Department, from June 2017 to December 2017. To assess the correlation between platelet to lymphocyte parameters and severity of CAD, the sample was divided according to the angiographic severity of CAD by using Gensini score into three groups, Group I Gensini score ranged from zero to 50, Group II Gensini score ranged from 50 to 100 and Group III Gensini score more than 100.Results: Patients with high PLR showed significant tach-ycardia at onset of admission, higher glucose level, higher Killip class II-IV, lower final angiographic TIMI flow, higher Gens iniscore, higher serum LDL level, lower HDL levels and higher triglycerides level, higher all the composite end-points of Major Adverse Cardiovascular Events (MACE) including death, reinfarction and Congestive Heart Failure (CHF).Conclusion: Platelets to lymphocytes ratio is an independ-ent prognostic factor for severity and complexity of CAD in patients with STEMI undergoing primary PCI intervention by using Gensini score.

The Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Short Term Outcome in Patients with Acute ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

AbstractBackground: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment elevation myocardial infarction (STEMI). Monocyte to HDL ratio (MHR) was defined as a novel potential marker to determine inflammation and used to predict clinical outcome in patients with STEMI.Objectives: To study the relation between monocyte to high-density lipoprotein cholesterol ratio and short-term outcome in patients with acute ST-segment elevation myocar-dial infarction undergoing primary percutaneous coronary intervention (PCI).Methods: This study was conducted on a number of 100 patients diagnosed with STEMI and underwent primary PCI in Tanta University Hospitals, Cardiovascular Department, from June 2017 to December 2017. The primary end points were all cause mortality and major adverse cardiovascular events (MACE) including a composite of death, nonfatal re-infarction, target vessel re-vascularization, or new onset congestive heart failure during hospitalization and during the 3-months clinical follow-up.Patients were divided into 3 tertiles according to the monocyte to high- density lipoprotein cholesterol ratio (MHR); Tertile 1: MHR20 (number of patients=23).Results: Patients in the high MHR tertile showed signif-icantly lower systolic blood pressure, higher Killip class II-IV, lower final angiographic TIMI flow, higher WBCs, neu-trophils and monocytes count, higher serum LDL level and lower HDL levels, higher ejection fraction, higher all the composite endpoints of MACE including death, reinfarction and CHF. The study showed that MHR level >12.3 predicted the overall MACE following STEMI with a sensitivity and specificity above 75%. Conclusion: Monocyte to high-density lipoprotein cho-lesterol ratio is an independent prognostic factor for both in-hospital adverse outcomes, as well as, short-term adverse outcomes among STEMI patients who underwent primary PCI.

Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up).

The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16–18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better survival over a 30-month follow-up period.

Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients

ObjectiveThe influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). MethodsIn a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. ResultsA total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. ConclusionInitial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.

Incidence, facteurs associés et devenir de l’insuffisance cardiaque hospitalière compliquant l’infarctus antérieur aigu traité avec succès par angioplastie primaire

Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. MethodsEighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. ResultsFifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. ConclusionIn conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.

Does pre-PCI angiographic TIMI flow in the culprit coronary artery influence infarct size and microvascular obstruction in acute STEMI patients?

Does pre-PCI angiographic TIMI flow in the culprit coronary artery influence infarct size and microvascular obstruction in acute STEMI patients?

Non-invasive coronary flow reserve after successful primary angioplasty for acute anterior myocardial infarction is an independent predictor of left ventricular adverse remodelling

To assess the usefulness of non-invasive coronary flow reserve (CFR) to predict left ventricular adverse remodelling (LVR) after ST-elevation myocardial infarction (STEMI). Sixty-five consecutive patients (mean age 58 +/- 13 years, 24 women) with a first anterior STEMI, underwent prospectively CFR in the distal part of the left anterior descending artery (LAD), using intravenous adenosine infusion (0.14 mg/kg/min, within 2 min), and a standard echocardiography during the same exam, performed within 24 h after successful primary coronary angioplasty, and 6 months later, while the patients were in stable haemodynamic situation. CFR was defined as the peak hyperaemic LAD flow velocity divided by the baseline flow velocity. LV end-systolic volume (ESV) and end-diastolic volume (EDV), and LV ejection fraction (LVEF) were measured using the biplane Simpson's rule. LVR was defined as an absolute increase of ESV > or =15%. Compared with patients without LVR, patients with LVR (n = 18) had higher peak troponin T levels, wall motion score (WMS), a worse initial angiographic TIMI flow grade, and less improved electrocardiographic ST-segment resolution (all P < 0.05), and lower CFR (1.43 +/- 0.2 vs. 1.97 +/- 0.5, P < 0.01). At 6 months, patients with LVR had higher WMS, ESV, EDV, and lower LVEF compared with patients without LVR (all P < 0.01). Furthermore, acute CFR was significantly correlated to the 6-month LVEF and ESV, and to change of LVEF and ESV (all P < 0.01). In the multivariate analysis, acute CFR and initial angiographic TIMI flow grade were the independent predictors of LVR (all P < or = 0.01). Receiver-operating characteristic curve analysis demonstrated that a cut-off value of 1.7 for CFR yields a sensitivity of 100% and a specificity of 62% to predict LVR at follow-up (P < 0.001, area under the curve 0.82). Non-invasive CFR is an independent predictor of LVR after successful primary angioplasty of anterior STEMI.

052 Determinants of st segment resolution after primary pci for stemi

ST segment resolution (STR) is a recognized intermediate prognosis parameter in STEMI reflecting the quality of tissue reperfusion. The aim of our study was to identify clinical, biological and angiographic determinants of STR. 157 consecutive patients treated by primary PCI within 6 hours of symptom onset were included. STR was calculated in the lead with maximal ST segment elevation. Complete STR was defined as a regression more than 70%. Mean age of the population was 58,7±13,7 ans, the sex ratio 4 men for one woman. Maximal ST segment elevation was 0,33±0,18 mV before and 0,16Âc0,19 mV 59± minutes after PCI. Complete STR was achieved in 43,3% of patients. STR significantly correlated with enzymatic peak CPK (r= -0,33 p<0,00001), peak troponine I (r= -0,26 p=0,01), echographic LVEF (r=0,35 p<0,0001) and plasmatic creatinin concentration 48 hours after admission (r= -0,31 p=0,0001). In univariate analysis, complete STR was significantly associated with young age, an elevated SpO 2 , angiographic TIMI flow grade 2 or 3 before angioplasty, low plasmatic BNP or HbA1c or fibrinogen concentrations. A trend of association for complete STR was observed with Killip class (p=0,075), number of Q waves (p=0,075), the use of direct stenting (p=0,08) and the use of abciximab (p=0,07). In multivariate analysis the independant predictors of STR were inferior location of infarction (OR=1,35 ; IC 1,16-1,55), TIMI risk score<5 (OR=1,24 ; IC 1,05-1,59) and angiographic TIMI flow grade 2 or 3 before angioplasty (OR=1,07 IC 1,009-1,15). Our results suggest that STR is related to the size of myocardial infarction. The resolution of ST elevation is multifactorial and mainly deriven by inferior location of myocardial infarction, low TIMI risk score and better angiographic TIMI flow grade before PCI (>1).

Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction.

Slow/no-reflow phenomenon is a serious problem complicating primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and is associated with a poor prognosis. From January 2002 to November 2002, 11 of the 70 consecutive patients with ST elevation AMI who were subjected to primary PCI using balloon angioplasty and/or stenting developed slow/no-reflow phenomenon (TIMI 1 flow in 2, TIMI 2 in 8, and TIMI 2.5 in 1). They were 10 men and 1 woman, aged 64 +/- 11 years (range, 46-81). The culprit vessels were six in the left anterior descending coronary artery, three in the right coronary artery, one in the left circumflex coronary artery, and one in saphenous vein graft. Multiple bolus doses (100 microg) of nitroprusside were injected into the index artery through the guiding catheter using a 3 ml syringe until the TIMI flow grade improved by at least one grade or the systolic pressure decline below 80 mm Hg (one patient). The total drug dose varied from 100 to 700 microg. Following the drug treatment, angiographic TIMI flow grade improved by at least one grade in 9 (82%) of the 11 patients (P = 0.007). The TIMI frame counts significantly decreased from 36 +/- 17 frame counts to 16 +/- 11 frame counts (P = 0.012). All patients were discharged without major adverse cardiovascular events. Intracoronary bolus injection of nitroprusside using a 3 ml syringe appears to be a feasible, safe, and effective technique for the management of slow/no-reflow phenomenon complicating primary PCI.