Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: Results from the HORIZONS-AMI trial

Adriano Caixeta, Alexandra J. Lansky, Roxana Mehran, Sorin J. Brener, Bimmer Claessen, Philippe Genereux, Tullio Palmerini, Bernhard Witzenbichler, Giulio Guagliumi, Bruce R. Brodie, Dariusz Dudek, Martin Fahy, George D. Dangas, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Aims: The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study. Methods and results: The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5%) and 2,758 patients (87.1%) had final TIMI 3 flow, while 407 (12.9%) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95% CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95% CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95% CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; p<0.0001). Conclusions: In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

Original languageEnglish (US)
Pages (from-to)220-227
Number of pages8
JournalEuroIntervention
Volume9
Issue number2
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Angioplasty
Myocardial Infarction
Platelet Glycoprotein GPIIb-IIIa Complex
Mortality
Age Factors
Multicenter Studies
Heparin
Clinical Trials
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Caixeta, Adriano ; Lansky, Alexandra J. ; Mehran, Roxana ; Brener, Sorin J. ; Claessen, Bimmer ; Genereux, Philippe ; Palmerini, Tullio ; Witzenbichler, Bernhard ; Guagliumi, Giulio ; Brodie, Bruce R. ; Dudek, Dariusz ; Fahy, Martin ; Dangas, George D. ; Stone, Gregg W. / Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction : Results from the HORIZONS-AMI trial. In: EuroIntervention. 2013 ; Vol. 9, No. 2. pp. 220-227.
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title = "Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: Results from the HORIZONS-AMI trial",
abstract = "Aims: The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study. Methods and results: The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5{\%}) and 2,758 patients (87.1{\%}) had final TIMI 3 flow, while 407 (12.9{\%}) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95{\%} CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95{\%} CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95{\%} CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95{\%} CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5{\%} vs. 10.5{\%}; p<0.0001). Conclusions: In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9{\%} of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.",
author = "Adriano Caixeta and Lansky, {Alexandra J.} and Roxana Mehran and Brener, {Sorin J.} and Bimmer Claessen and Philippe Genereux and Tullio Palmerini and Bernhard Witzenbichler and Giulio Guagliumi and Brodie, {Bruce R.} and Dariusz Dudek and Martin Fahy and Dangas, {George D.} and Stone, {Gregg W.}",
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Caixeta, A, Lansky, AJ, Mehran, R, Brener, SJ, Claessen, B, Genereux, P, Palmerini, T, Witzenbichler, B, Guagliumi, G, Brodie, BR, Dudek, D, Fahy, M, Dangas, GD & Stone, GW 2013, 'Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: Results from the HORIZONS-AMI trial', EuroIntervention, vol. 9, no. 2, pp. 220-227. https://doi.org/10.4244/EIJV9I2A37

Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction : Results from the HORIZONS-AMI trial. / Caixeta, Adriano; Lansky, Alexandra J.; Mehran, Roxana; Brener, Sorin J.; Claessen, Bimmer; Genereux, Philippe; Palmerini, Tullio; Witzenbichler, Bernhard; Guagliumi, Giulio; Brodie, Bruce R.; Dudek, Dariusz; Fahy, Martin; Dangas, George D.; Stone, Gregg W.

In: EuroIntervention, Vol. 9, No. 2, 01.01.2013, p. 220-227.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction

T2 - Results from the HORIZONS-AMI trial

AU - Caixeta, Adriano

AU - Lansky, Alexandra J.

AU - Mehran, Roxana

AU - Brener, Sorin J.

AU - Claessen, Bimmer

AU - Genereux, Philippe

AU - Palmerini, Tullio

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Brodie, Bruce R.

AU - Dudek, Dariusz

AU - Fahy, Martin

AU - Dangas, George D.

AU - Stone, Gregg W.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Aims: The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study. Methods and results: The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5%) and 2,758 patients (87.1%) had final TIMI 3 flow, while 407 (12.9%) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95% CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95% CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95% CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; p<0.0001). Conclusions: In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

AB - Aims: The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study. Methods and results: The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5%) and 2,758 patients (87.1%) had final TIMI 3 flow, while 407 (12.9%) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95% CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95% CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95% CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; p<0.0001). Conclusions: In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

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