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TIMI perfusion grade compared to TIMI flow in prediction of infarct size and microvascular obstruction measured by contrast-enhanced MRI
Journal of Cardiovascular Magnetic Resonance volume 11, Article number: P231 (2009)
Background
The TIMI perfusion grade (TMPG) and TIMI flow are angiographic parameters with prognostic impact in ST-elevation myocardial infarction (STEMI). The association of these parameters with infarct size and microvascular obstruction assessed by MRI, which also have of prognostic impact, has not been studied so far.
Methods
From 02/2006–01/2008 280 consecutive patients with STEMI underwent primary PCI. In an MRI study (day 1–4 after PCI) infarct size and microvascular obstruction in percent of left ventricular mass (%LV) were measured by delayed enhancement. In addition, post-PCI TIMI flow and TMPG were assessed from invasive angiography. All measurements were done by blinded investigators. TMPG and TIMI flow were graded as severely impaired (0–1) or mildly impaired-normal (2–3).
Results
For post-PCI TIMI flow there was a significant difference in the extent of microvascular obstruction (TIMI 0–1: 6.6 ± 5.1%LV vs. TIMI 2–3: 3.6 ± 4.6%LV, p = 0.021), but no significant difference in infarct size (TIMI 0–1: 25.9 ± 15.3%LV vs. TIMI 2–3: 21.19.3 ± 13.4, p = 0.07). For TMPG microvascular obstruction (TMPG 0–1: 5.3 ± 5.2%LV vs. TMPG 2–3: 3.5 ± 4.5%LV, p = 0.011) and infarct size were significantly different (TMPG 0–1: 25.0 ± 13.0%LV vs. 18.6 ± 13.5%LV, p = 0.002). In a multivariable model the strongest predictors of infarct size and microvascular obstruction were post-PCI TMPG, infarct location, Killip class, and 90 minute ST-segment resolution (p < 0.005 for all).
Conclusion
In STEMI patients undergoing primary PCI the TMPG is a better indicator of angiographic success compared to TIMI flow reflected by a significant difference in infarct size measured by cardiac MRI. This might explain why the TMPG has additional prognostic impact in patients with restoration of normal TIMI flow.
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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Fuernau, G.F., Schindler, K., Eitel, I. et al. TIMI perfusion grade compared to TIMI flow in prediction of infarct size and microvascular obstruction measured by contrast-enhanced MRI. J Cardiovasc Magn Reson 11 (Suppl 1), P231 (2009). https://doi.org/10.1186/1532-429X-11-S1-P231
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DOI: https://doi.org/10.1186/1532-429X-11-S1-P231
Keywords
- Myocardial Infarction
- Infarct Size
- TIMI Flow
- Left Ventricular Mass
- Prognostic Impact