CLINICAL SIGNIFICANCE OF PRE-PROCEDURE THROMBOLYSIS IN MYOCARDIAL INFARCTION FLOW IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFRACTION

Abstract

Objective: To assess the clinical implications of pre-procedure Thrombolysis in Myocardial Infarction (TIMI) flow and its relationship to in-hospital outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A descriptive cross-sectional study was carried out at National Institute of Cardiovascular Diseases (NICVD), Karachi, in Adult Cardiology Department. There was a total of 316 consecutive patients aged 18 to 70 years who had a presentation of STEMI and primary PCI within 24 hours of onset of symptoms. Coronary angiography was performed pre-procedure to determine TIMI flow grade and patients were divided into impaired flow (TIMI 0/I) and preserved flow (TIMI II/III). In-hospital outcomes including slow flow/no-reflow, cardiogenic shock, malignant ventricular arrhythmias, heart failure requiring medical therapy, mechanical ventilation, intra-aortic balloon pump support, in-hospital mortality, and length of hospital stay were assessed. Results: Of 316 patients, 228 (72.2%) had impaired pre-procedure (TIMI 0/I) and preserved (TIMI II/III) flow in 88 (27.8%) patients. Patients with impaired TIMI flow had higher rates of slow flow / no reflow (20.2% vs 6.8%, p=0.003), malignant ventricular arrhythmias (23.2% vs 10.2%, p=0.009), heart failure requiring medical therapy (34.2% vs 13.6%, p<0.001), and longer hospital stay (37.7% vs 20.5%, p=0.004) than patients with preserved flow. Conclusion: There was a correlation between impaired pre-procedure TIMI flow and in-hospital adverse outcomes in STEMI patients undergoing primary PCI. Pre-procedure TIMI flow assessment might be a valuable angiographic tool for early risk stratification and outcome prediction.