Prognostic impact of pre-percutaneous coronary intervention TIMI flow in ST and non-ST elevation myocardial infarction patients: Results from the FAST-MI 2010 registry

Background Thrombolysis in myocardial infarction ( TIMI) flow grade 2 or 3 before percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) is associated with improved outcomes. No recent data, however, are available on its impact beyond one year and/or by type of AMI. Aims To assess the prognostic impact of pre-PCI TIMIflow at 30 days and 3 years in ST-elevation(STEMI) and non- ST-elevation(NSTEMI) AMI patients. Methods We compared long-term outcomes associated with TIMIflow grade 2/3 versus 0/1 in patients referred for PCI in the FAST-MI 2010 nationwide French registry. Results TIMIflow grade 2/3 was found in 41% of STEMI and 69% of NSTEMI patients. It was associated with lower 30-day death in STEMI patients (OR: 0.30; 95% CI: 0.12 to 0.77, P = 0.01) but not in NSTEMI patients (OR 0.57; 95% CI: 0.22 to 1.42, P = 0.23). TIMIgrade flow 2/3 was also associated with lower risk of 3-year death in STEMI patients (HR: 0.69; 95% CI: 0.49 to 0.98, P = 0.04) but not in NSTEMI patients (HR 0.79; 95% CI: 0.56 to 1.11, P = 0.17). Conclusion TIMIflow grade 2/3 is observed more often in NSTEMI patients. It represents an independent predictor of early and late survival in STEMI patients but is not significantly related to early or long-term survival in NSTEMI patients. Clinicaltrials.gov identifier: NCT01237418 .