Pablo Castro Gálvez

Prognostic Value of Noninvasive Markers of Coronary Reperfusion Compared to TIMI 3 Flow in Patients Treated With Primary Angioplasty

60 Introduction and objectives. The aim of this study was to compare the prognostic value of TIMI 3 flow ver- sus noninvasive markers of coronary artery reperfusion on the outcome of patients with a recent acute myocardial infarction (AMI) treated with primary angioplasty. Patients and method. We analyzed 172 consecutive patients with AMI and ST-segment elevation, who were treated with primary angioplasty within 12 hours of admis- sion. Mean age was 61±13 years, 77% were men, and 56% had a history of previous AMI. Results. In-hospital mortality was 3.6%; 16.6% develo- ped heart failure, and 11.1% had complex arrhythmias du- ring their hospital stay. The noninvasive criterion for suc- cessful reperfusion was the presence of two or more markers of reperfusion based on ECG changes or CK le- vels after angioplasty. Reperfusion was successful in 87.7% of the patients, and TIMI 3 flow was achieved in 87%. There was no significant concordance between the two methods (kappa index =0.012). Multivariate analysis showed that both successful reperfusion (OR=0.028; 95% CI, 0.003-0.268) and TIMI 3 flow (OR=0.104; 95% CI, 0.019-0.563) were protective for in-hospital mortality. How- ever, in the multivariate analysis only successful reperfu- sion was a protective factor for heart failure and complex arrhythmias. Conclusion. Our findings confirm that both TIMI 3 flow and successful coronary reperfusion evaluated non- invasively show independent prognostic value in patients with AMI treated with primary angioplasty. Noninvasive markers of coronary reperfusion should be used as com- plementary to angiography in these patients.