Significance of thrombolysis in myocardial infarction (TIMI) grade 2 flow early after thrombolysis followed by immediate percutaneous coronary intervention in patients with acute myocardial infarction

Abstract

Although pre-interventional thrombolysis has recently been shown to restore early patency and preserve left ventricular function in patients with acute myocardial infarction, the significance of Thrombolysis in Myocardial Infarction (TIMI) grade flow early after thrombolysis remains unclear. Patients were classified into 3 groups according to TIMI grade flow 45 min after thrombolysis; 38 patients with TIMI grade 0 or 1 flow (group T0) and 46 with TIMI grade 2 flow (group T2) additionally received immediate percutaneous coronary intervention (PCI) and 50 patients with TIMI grade 3 flow (group T3) were treated conservatively after thrombolysis. Although the door-to-balloon times did not differ in groups T0 and T2, group T2 had lower peak creatine kinase, a higher rate of complete (≤70%) ST resolution and better regional wall motion at discharge as compared with group T0, similar to group T3 (group T2, group T3 vs group T0; 2,857±1,756, 2,314±1,948 vs 3,779±2,214mU/ml; 57, 72 vs 34%; -1.5±1.6, -1.2±1.6 vs -2.2±1.6; all p<0.01, respectively). These results suggest TIMI grade 2 flow at 45 min after thrombolysis followed by immediate PCI, as well as TIMI grade 3 flow, is associated with greater myocardial salvage than TIMI grade 0 or 1 flow.