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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Keywords: akuter Myokardinfarkt,  Infarktstelle,  Prognose,  Thrombolyse,  acute myocardial infarction,  infarct location,  prognosis,  thrombolysis

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.