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Zeymer U et al.  
Influence of infarct location on the prognostic impact of thrombolysis in myocardial infarction (TIMI) perfusion grade of the infarct-related artery after thrombolysis for acute myocardial infarction

Journal of Clinical and Basic Cardiology 2000; 3 (1): 43-45

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Fig. 1: Akuter Myokardinfarkt - Thrombolyse - Spitalsmortalität

Keywords: akuter MyokardinfarktInfarktstellePrognoseThrombolyseacute myocardial infarctioninfarct locationprognosisthrombolysis

The influence of the infarct location on the impact of the 90 minute patency status of the infarct vessel on in-hospital mortality was evaluated in 1569 patients treated with thrombolysis for acute myocardial infarction in seven angiographic trials with similar design. Of the 1569 patients 1512 (96.3 %) had a 90-minute angiogram of the infarct-related artery. In 22 patients the infarct vessel could not be determined angiographically. In the remaining 1490 patients the infarct vessel was the left anterior descending coronary artery in 42 %, the right coronary artery in 44 % and the left circumflex coronary artery in 14 %. The in-hospital mortality in the 1490 patients was 4.2 %. The infarct location as determined by the baseline ECG was anterior in 42.6 % and inferior in 57.4 %, while the mortality was 5.5 % and 3.1 % in patients with anterior and inferior infarctions, respectively (p = 0.035). The mortality rates in patients with TIMI grade 0/1, 2 and 3 flow were 10.9 %, 6.2 % and 3.0 % anterior infarcts and 5.4 %, 4.1 % and 1.7 % for inferior infarcts, respectively. This is the first study which demonstrated differences in the prognostic impact of 90-minute TIMI grade 2 flow of the infarct-vessel related to infarct location. While mortality in patients with inferior infarcts and TIMI 2 patency is similar to that with TIMI 0/1 patency, in patients with anterior infarcts, mortality with TIMI 2 flow is better than with TIMI 0/1 patency, but not equivalent to TIMI 3 flow. Therefore although TIMI 3 patency should be the primary aim of any reperfusion therapy, achievement of TIMI 2 patency in patients with anterior infarcts should no longer be considered as therapy failure. J Clin Basic Cardiol 2000; 3: 43-5.
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