Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction

• Published in: Journal of the American College of Cardiology Vol. 35; no. 6; pp. 1516 - 1524
• Main Authors: French, John K, Hyde, Thomas A, Straznicky, Ivan T, Andrews, Jacqueline, Lund, Mayanna, Amos, David J, Zambanini, Andrew, Ellis, Christopher J, Webber, Bruce J, McLaughlin, Stephanie C, Whitlock, Ralph M.L, Manda, Samuel O.M, Patel, Hitesh, White, Harvey D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2000; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Blood Flow Velocity - drug effects; Blood. Blood coagulation. Reticuloendothelial system; Coronary Angiography - drug effects; Coronary Circulation - drug effects; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; Streptokinase - administration & dosage; Survival Rate; Thrombolytic Therapy; Tissue Plasminogen Activator - administration & dosage; Treatment Outcome; GUSTO; CASS; CTFC; TIMI; IQR; GISSI; HEAP; Human; Chemotherapy; Prognosis; Treatment; Infarct; Follow up study; Myocardium; Cardiovascular disease; Coronary heart disease; Myocardial disease; Survival; Fibrinolytic
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(00)00577-5

OBJECTIVES
To evaluate the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CTFC) as a predictor of late survival after myocardial infarction.
BACKGROUND
Thrombolysis in Myocardial Infarction flow grades predict late survival after myocardial infarction. The CTFC provides a more reproducible measurement of infarct-related artery blood flow than the TIMI flow grade, and has been linked to 30-day outcomes, but it has not yet been established how the CTFC correlates with late survival.
METHODS
Of 1,001 patients with acute myocardial infarction presenting within 4 h of symptom onset, 882 underwent angiography at approximately three weeks. Infarct artery flow was assessed, blinded to clinical outcomes, according to the CTFC and TIMI flow grade. Late cardiac mortality and survival were determined in 97.5% of patients.
RESULTS
The mean CTFC was 40 ± 29 in 644 patent infarct arteries (median, 34 [interquartile range, 24 to 47]). The CTFC, assessed as a continuous univariate variable, was found to be a predictor of five-year survival, as was the TIMI flow grade (both p < 0.001). On multivariate analysis, factors associated with five-year survival included the ejection fraction or end-systolic volume index (both p < 0.001), exercise duration (p = 0.005), age (p = 0.008), diabetes (p = 0.02) and CTFC (p = 0.02) or TIMI flow (p = 0.02). The same factors, except for the CTFC and TIMI flow grade, were predictors of 10-year survival.
CONCLUSIONS
The CTFC three weeks after myocardial infarction was an independent predictor of five-year survival, but not 10-year survival. Although the CTFC provided additional prognostic information within TIMI flow grades, its superiority was not demonstrated.