Target vessel reopening by guidewire insertion in ST-elevation myocardial infarction is a predictor of final TIMI flow and survival

Christopher Adlbrecht; Klaus Distelmaier; Duygu Gündüz; Bassam Redwan; Christian Plass; Diana Bonderman; Alexandra Kaider; Günter Christ; Irene M. Lang

doi:10.1160/TH10-04-0246

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2011; 105(01): 52-58
DOI: 10.1160/TH10-04-0246

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Target vessel reopening by guidewire insertion in ST-elevation myocardial infarction is a predictor of final TIMI flow and survival

Authors

Christopher Adlbrecht

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Klaus Distelmaier

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Duygu Gündüz

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Bassam Redwan

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Christian Plass

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Diana Bonderman

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Alexandra Kaider

²The Core Unit for Medical Statistics and Informatics, Vienna, Austria
Günter Christ

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
Irene M. Lang

¹Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria

Abstract

Summary

ST-elevation myocardial infarction (STEMI) results from acute thrombotic obstruction of a coronary artery. Percutaneous coronary intervention (PCI) is the treatment of choice to restore blood flow. The incidence of guidewire-induced reopening of the infarct-related coronary artery (IRA) and its association with post-procedural TIMI flow and long-term mortality were assessed. Angiograms of consecutive STEMI patients admitted to the catheter laboratory of the Medical University of Vienna between January 2003 and December 2005 were analysed. TIMI flow was graded prior to and after guidewire insertion into the distality of the IRA, and at the end of the procedure. Initial TIMI 0 flow was present in 476 (47.0%) of 1,012 cases. Target vessel reopening after guidewire insertion defined as any flow >TIMI 0 flow occurred in 150 patients (37.2%), and was associated with improved survival after a median of 914 (609–1,238) days (p=0.017). Reflow after guidewire insertion was an independent predictor of post-procedural TIMI flow (odds ratio=3.10, 95% confidence interval [CI]=1.64 – 5.86], p<0.001) and mortality (hazard ratio=0.51, CI=0.28 – 0.94], p=0.029). Target vessel reopening by guidewire insertion is a new predictor of prognosis. Target vessel flow after guidewire insertion should be assessed in a standardised fashion during PCI.

Keywords

Myocardial infarction - prognosis - thrombectomy - guidewire - reper-fusion

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Referenzen

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