TY - JOUR
T1 - Impact of preprocedural TIMI flow on clinical outcome in low-risk patients with ST-elevation myocardial infarction: Results from the ATLANTIC study
AU - Bauer, T.
AU - Zeymer, U.
AU - Diallo, A.
AU - Vicaut, E.
AU - Bolognese, L.
AU - Cequier, A.
AU - Huber, K.
AU - Montalescot, G.
AU - Hamm, C.W.
AU - van 't Hof, A.W.
AU - ATLANTIC Investigators
N1 - Funding Information:
Dr. Bauer has received speaker fees from AstraZeneca. Dr. Zeymer reports personal fees from AstraZeneca, during the conduct of the study; personal fees from AstraZeneca, grants and personal fees from Daiichi Sankyo, Eli Lilly, personal fees from Bayer Healthcare, The Medicines Company, grants and personal fees from Sanofi, Novartis, personal fees from Boehringer Ingelheim, MSD, outside the submitted work. Dr. Vicaut reports receiving fees for serving on a data and safety monitoring board at the European Cardiovascular Research Center, consulting fees from Abbott Laboratories, Bristol-Myers Squibb, Celgene, Fresenius, LFB, Eli Lilly, Medtronic, Pfizer, and Sanofi-Aventis, lecture fees from Novartis, and grant support from Boehringer Ingelheim and Sanofi-Aventis. Dr. Bolognese reports receiving consulting and lecture fees and fees for board membership from Daiichi Sankyo, Eli Lilly, Menarini, AbbottLaboratories, AstraZeneca, and Iroko Cardio International. Dr. Cequier reports receiving consulting/lectures fees from AstraZeneca, Abbott Vascular, Medtronic, Boston Scientific, Biotronic, Ferrer, and Daiichi Sankyo, and grant support from Abbott Vascular, Medtronic, and Spanish Society of Cardiology. Dr. Huber has received speaker fees from AstraZeneca. Dr. Montalescot reports research Grants to the Institution or Consulting/Lecture Fees from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, Cardiovascular Research Foundation, Daiichi Sankyo, Idorsia, Lilly, Europa, Elsevier, Fédération Française de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, MSD, Novo-Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School, TIMI Study Group, WebMD. Dr. Hamm reports receiving lecture fees from Daiichi Sankyo, Correvio, and Sanofi-Aventis and grant support from AstraZeneca. Dr. van 't Hof reports receiving consulting fees from the Medicines Company, Eli Lilly, and Daiichi Sankyo, lecture fees from the Medicines Company, Eli Lilly, Daiichi Sankyo, Medtronic, and Correvio, and grant support from the Medicines Company, Eli Lilly, Daiichi Sankyo, Medtronic, Abbott Laboratories, and Correvio. All other authors have reported that they have no relationships relevant to the contents of this article to disclose.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/2/15
Y1 - 2020/2/15
N2 - OBJECTIVES This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST-elevation myocardial infarction (STEMI).BACKGROUND Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline-adherent therapy.METHODS The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3.RESULTS From a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p < .05) and all-cause death (3.0, 1.4, and 2.1%, p = .30) were highest in patients with TIMI flow 0/1. After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74-4.85). However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. 1.3%, p < .05).CONCLUSION In this post-hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events.
AB - OBJECTIVES This study sought to analyze the impact of the preprocedural thrombolysis in myocardial infarction (TIMI) flow on clinical outcome in patients with ST-elevation myocardial infarction (STEMI).BACKGROUND Previous studies have shown that the TIMI flow 0/1 prior to primary percutaneous coronary intervention (PCI) is associated with a poor clinical outcome. However, it is unclear whether the same is true in patients with ongoing STEMI of less than 6 hr duration, rapid reperfusion, and modern guideline-adherent therapy.METHODS The ATLANTIC study compared prehospital versus inhospital treatment with ticagrelor in patients with acute STEMI. For this analysis, patients were divided into three groups according to the preprocedural TIMI flow grade of the infarct vessel: TIMI 0/1, TIMI 2, and TIMI 3.RESULTS From a total of 1,680 patients, 1,113 had TIMI 0/1, 279 TIMI 2, and 288 TIMI 3 flow before primary PCI. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p < .05) and all-cause death (3.0, 1.4, and 2.1%, p = .30) were highest in patients with TIMI flow 0/1. After adjustment, preprocedural TIMI flow <3 (versus 3) was not an independent predictor of major adverse ischemic events within 30 days (odds ratio 1.89, 95% confidence interval 0.74-4.85). However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. 1.3%, p < .05).CONCLUSION In this post-hoc analysis, preprocedural TIMI flow was not independently associated with a higher rate of adverse ischemic events.
KW - artery patency
KW - pci
KW - percutaneous coronary intervention
KW - prehospital ticagrelor
KW - primary angioplasty
KW - reperfusion
KW - stemi
KW - stent thrombosis
KW - timi flow grade
KW - ARTERY PATENCY
KW - REPERFUSION
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - PREHOSPITAL TICAGRELOR
KW - PCI
KW - STEMI
KW - TIMI flow grade
KW - PRIMARY ANGIOPLASTY
U2 - 10.1002/ccd.28318
DO - 10.1002/ccd.28318
M3 - Article
C2 - 31067010
SN - 1522-1946
VL - 95
SP - 494
EP - 500
JO - Catheterization and Cardiovascular interventions
JF - Catheterization and Cardiovascular interventions
IS - 3
ER -