Outcome of poor initial TIMI flow in patients presenting with acute coronary syndrome

Figures & data

Table 1. Baseline clinical, angiographic and procedural characteristics of the 2 unmatched groups.

Variable	Poor initial TIMI group N = 279	Good initial TIMI group N = 547	p Value
Age (years)	60.7 ± 11.5	64.2 ± 11.9	<.001
Female gender	57 (20.4)	141 (25.8)	.089
Diabetes mellitus	47 (16.8)	93 (17.0)	.95
Current smoker	112 (40.1)	166 (30.3)	.005
Hyperlipidemia	100 (35.8)	287 (52.5)	<.001
Hypertension	108 (38.7)	305 (55.8)	<.001
Presentation by ST-elevation MI	209 (74.9)	112 (20.5)	<.001
Prior MI	24 (8.6)	72 (13.2)	.053
Prior PCI	17 (6.1)	65 (11.9)	.008
Prior CABG	9 (3.2)	28 (5.1)	.21
ACC/AHA Lesion type B/C	273 (97.8)	457 (83.5)	<.001
Left anterior descending artery	108 (38.7)	262 (47.9)	.012
Thrombus	233 (83.5)	131 (23.9)	<.001
Calcified lesions	106 (38.0)	246 (45.0)	.055
Bifurcation lesions	55 (19.7)	121 (22.1)	.42
Reference vessel diameter (mm)	3.11 ± 0.41	3.15 ± 0.44	.18
Lesion length (mm)	14.9 ± 5.3	14.1 ± 6.2	.081
Stent diameter (mm)	3.12 ± 0.43	3.17 ± 0.45	.12
Stent length (mm)	18.7 ± 5.4	17.9 ± 5.4	.079
Total stent length per lesion (mm)	21.8 ± 9.6	20.1 ± 8.4	.016
Number of vessels treated per patient	1.09 ± 0.32	1.17 ± 0.43	<.004
Number of lesions treated per patient	1.14 ± 0.47	1.22 ± 0.52	.043
Stents per culprit lesion	1.17 ± 0.40	1.13 ± 0.35	.25
Pre-dilatation	175 (62.7)	391 (71.5)	.01
Thrombus aspiration	134 (48.0)	20 (3.7)	<.001
Post-dilatation	113 (40.5)	243 (44.4)	.28
Final TIMI flow grade 3	271 (97.1)	544 (99.5)	.009
Stent failure	2 (0.7)	3 (0.5)	1.00
Procedural success	277 (99.3)	547 (100)	.11
Unfractionated heparin	80 (28.7)	135 (24.7)	.21
Low-molecular-weight heparin	126 (45.2)	356 (65.1)	<.001
Glycoprotein IIb IIIa inhibitor	122 (43.7)	120 (21.9)	<.001
Bivalirudin	72 (25.8)	49 (9.0)	<.001

Continuous variables are presented as mean ± SD, whereas categorical variables are presented as frequency (percentage).

ACC: American College of Cardiology; AHA: American Heart Association; CABG: coronary artery bypass grafting; MI: myocardial infarction; PCI: percutaneous coronary intervention; TIMI: Thrombolysis In Myocardial Infarction.

Figure 1. Kaplan-Meier estimates of the primary endpoint (a composite of cardiac death, non-fatal myocardial infarction, or ischemia-driven target lesion revascularization) in the 2 groups at long-term follow-up. MACE: major adverse cardiac events.

Table 2. Clinical outcome of the 2 unmatched groups at long-term follow-up.

	Poor initial TIMI group N = 279	Good initial TIMI group N = 547	Hazard ratio (95% CI)	p Value
MACE	39 (14.0)	87 (15.9)	0.86 (0.57–1.29)	.46
Cardiac Death	10 (3.6)	16 (2.9)	1.23 (0.55–2.76)	.60
Non-fatal MI	16 (5.7)	40 (7.3)	0.77 (0.42–1.40)	.39
Ischemia-driven TLR	21 (7.5)	47 (8.6)	0.87 (0.51–1.48)	.59
Non-cardiac Death	7 (2.5)	30 (5.5)	0.44 (0.19–1.02)	.051
Definite ST	10 (3.6)	8 (1.5)	2.51 (0.98–6.42)	.048
Early definite ST	7 (2.5)	3 (0.5)	4.67 (1.20–18.19)	.036
Late/very late definite ST	3 (1.1)	5 (0.9)	1.18 (0.28–4.97)	1.0

Variables are presented as frequency (percentage).

CI: confidence interval; MACE: major adverse cardiac events; MI: myocardial infarction; ST: stent thrombosis; TIMI: Thrombolysis In Myocardial Infarction; TLR: target lesion revascularization.

Table 3. Baseline clinical, angiographic and procedural characteristics of the 2 matched groups.

Variable	Poor initial TIMI group N = 108	Good initial TIMI group N = 108	p Value
Age (years)	62.5 ± 11.7	62.4 ± 11.9	.94
Female gender	24 (22.2)	16 (14.8)	.16
Diabetes mellitus	14 (13.0)	12 (11.1)	.67
Current smoker	39 (36.1)	36 (33.3)	.66
Hyperlipidemia	44 (40.7)	41 (38.0)	.67
Hypertension	49 (45.4)	46 (42.6)	.68
Presentation by ST-elevation MI	58 (53.7)	59 (54.6)	.89
Prior MI	12 (11.1)	11 (10.2)	.82
Prior PCI	9 (8.3)	8 (7.4)	.80
Prior CABG	7 (6.5)	5 (4.6)	.55
ACC/AHA Lesion type B/C	103 (95.4)	103 (95.4)	1.00
Left anterior descending artery	39 (36.1)	44 (40.7)	.48
Thrombus	68 (63.0)	65 (60.2)	.67
Calcified lesions	50 (46.3)	46 (42.6)	.58
Bifurcation lesions	24 (22.2)	24 (22.2)	1.00
Reference vessel diameter (mm)	3.09 ± 0.43	3.13 ± 0.44	.54
Lesion length (mm)	14.7 ± 5.6	14.6 ± 5.7	.88
Stent diameter (mm)	3.12 ± 0.46	3.15 ± 0.45	.60
Stent length (mm)	18.7 ± 5.7	18.7 ± 5.1	.99
Total stent length per lesion (mm)	21.1 ± 9.4	21.2 ± 8.3	.90
Number of vessels treated per patient	1.14 ± 0.37	1.10 ± 0.36	.45
Number of lesions treated per patient	1.18 ± 0.43	1.12 ± 0.38	.31
Stents per culprit lesion	1.14 ± 0.37	1.17 ± 0.37	.58
Pre-dilatation	78 (72.2)	81 (75.0)	.64
Thrombus aspiration	17 (15.7)	19 (17.6)	.71
Post-dilatation	39 (36.1)	42 (38.9)	.67
Final TIMI flow grade 3	106 (98.1)	105 (97.2)	1.00
Stent failure	1 (0.9)	2 (1.9)	1.00
Procedural success	108 (100)	108 (100)	NA
Unfractionated heparin	27 (25.0)	22 (20.4)	.41
Low-molecular-weight heparin	55 (50.9)	66 (61.1)	.13
Glycoprotein IIb IIIa inhibitor	33 (30.6)	38 (35.2)	.46
Bivalirudin	25 (23.1)	20 (18.5)	.40

Continuous variables are presented as mean ± SD, whereas categorical variables are presented as frequency (percentage).

ACC: American College of Cardiology; AHA: American Heart Association; CABG: coronary artery bypass grafting; MI: myocardial infarction; PCI: percutaneous coronary intervention; TIMI: Thrombolysis In Myocardial Infarction.

Table 4. Clinical outcome of the 2 matched groups at long-term follow-up.

	Poor initial TIMI group N = 108	Good initial TIMI group N = 108	Hazard ratio (95% CI)	p Value
MACE	15 (13.9)	16 (14.8)	0.93 (0.43–1.99)	.84
Cardiac Death	3 (2.8)	3 (2.8)	1.00 (0.19–5.07)	1.00
Non-fatal MI	9 (8.3)	5 (4.6)	1.87 (0.61–5.78)	.26
Ischemia-driven TLR	7 (6.5)	11 (10.2)	0.61 (0.23–1.64)	.32
Non-cardiac Death	2 (1.9)	7 (6.5)	0.27 (0.06–1.34)	.17
Definite ST	5 (4.6)	2 (1.9)	2.57 (0.49–13.56)	.44

Variables are presented as frequency (percentage).

CI: confidence interval; MACE: major adverse cardiac events; MI: myocardial infarction; ST: stent thrombosis; TIMI: Thrombolysis In Myocardial Infarction; TLR: target lesion revascularization.