The major entry criteria of these trials were similar and deliberately nonrestrictive 4–10 : patients of any age were enrolled with evidence of AMI of <12 hours’ duration.
This has not been demonstrated conclusively.ĭata from the 4 major PAMI trials (PAMI-1, 4,5 n=195 PAMI-2, 6,7 n=1100 PAMI Stent Pilot, 8,9 n=312 and the PAMI Stent Randomized Trial, 10 n=900) were pooled in a computerized database. If this theory is true, the outcomes of patients presenting to the cardiac catheterization laboratory with spontaneous TIMI-3 flow before primary PTCA should be improved compared with those in whom angioplasty is required to establish patency. 3,11 It has therefore been suggested that early pharmacological reperfusion before angiography and definitive mechanical intervention when appropriate (so-called facilitated primary angioplasty 12,13 ) may further improve outcomes in AMI. 1 Nonetheless, the inherent delay from hospital arrival to angioplasty, which averages ≈2 hours in the United States, 2–10 is considered a major drawback of primary PTCA and may adversely affect survival. These data warrant prospective randomized trials of pharmacological strategies to promote early reperfusion before definitive mechanical intervention in acute myocardial infarction.īy restoring high rates of normal antegrade epicardial (Thrombolysis In Myocardial Infarction grade 3 ) flow and avoids intracranial bleeding, primary PTCA has been shown to improve survival in patients with acute myocardial infarction (AMI) compared with thrombolytic therapy. By multivariate analysis, TIMI-3 flow before PTCA was an independent determinant of survival (odds ratio 2.1, P=0.04), even when corrected for by postprocedural TIMI-3 flow.Ĭonclusions- Patients undergoing primary PTCA in whom TIMI-3 flow is present before angioplasty present with greater clinical and angiographic evidence of myocardial salvage, are less likely to develop complications related to left ventricular failure, and have improved early and late survival. Cumulative 6-month mortality was 0.5% in patients with initial TIMI-3 flow, 2.8% with TIMI-2 flow, and 4.4% with initial TIMI-0/1 flow ( P=0.009). Patients with initial TIMI-3 flow had significantly lower in-hospital rates of mortality, new-onset heart failure, and hypotension and had a shorter hospital stay. Compared with patients without TIMI-3 flow, those with TIMI-3 flow before PTCA had greater left ventricular ejection fraction (57☑0% versus 53☑1%, P=0.003) and were less likely to present in heart failure (7.0% versus 11.6%, P=0.009). Methods and Results- Among 2507 patients enrolled in 4 PAMI trials undergoing primary PTCA, spontaneous reperfusion (TIMI-3 flow) was present in 16% at initial angiography. Customer Service and Ordering Informationīackground- Whereas survival after lytic therapy for myocardial infarction is strongly dependent on early administration, it is unknown whether the otherwise excellent outcomes in patients undergoing primary PTCA for acute myocardial infarction, in whom TIMI-3 flow rates of >90% may be achieved, can be further improved by early reperfusion.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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