![]() ![]() ![]() Among these patients, those with prehospital administration of ticagrelor were less often affected (0.3% vs. However, definite stent thrombosis occurred only in patients with initial TIMI flow 0/1 (1.0%). 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). 30) were highest in patients with TIMI flow 0/1. At 30 days, the composite ischemic endpoint (5.5, 2.9, and 2.1%, p <. 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. 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. Despite a better patency (TIMI 2 or 3 flow), a lower prevalence of thrombus or fresh occlusion and a better myocardial perfusion in the infarct-related region pre-PCI, no beneficial effect on post-PCI angiographic or clinical outcome was found, as compared to initiation of Tirofiban in the catheterisation laboratory.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. 7.0%, P = 0.99).Įarly initiation of Tirofiban did not improve initial TIMI 3 flow of the IRV significantly. At one-year follow-up, the combined incidence of death or recurrent MI was not different between the groups (7.0% vs. However, no difference in TIMI 3 flow or myocardial blush grade was found between the groups, post-PCI. A pre-PCI myocardial blush grades 2 or 3 was more often present in the Early group (30% vs. Thrombus or a fresh occlusion was present in 60% and 73% in the Early and Late group, respectively (P = 0.002). The combined incidence of TIMI 2 or 3 flow was present in 43% in the Early group and in 34% in the Late group, respectively (P = 0.04). At initial angiography, TIMI 3 flow was present in 19% the Early group and in 15% in the Late group (P = 0.22). In the Early group, Tirofiban was administered a median of 59 min (range 11-178 min) earlier than in the Late group. A large proportion of patients (41%) was diagnosed and randomised in the ambulance, without intervention of a physician. The effect of Tirofiban on each TIMI flow component, the presence of thrombus at initial angiography and pre-PCI myocardial blush grade were secondary end-points. The primary end-point was TIMI flow grade 3 of the infarct-related vessel (IRV) at initial angiography, as assessed by an independent core-lab. Although primary angioplasty is effective despite additional transportation delay, improved patency before PCI might be obtained by starting pharmacological pre-treatment before transportation.įrom June 2001 to November 2002, 507 patients with acute myocardial infarction, who were transferred to a PCI centre, were randomised to early, pre-hospital initiation of Tirofiban (Early) or to initiation in the catheterisation laboratory (Late). ![]()
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