Beyond TIMI 3 Flow CTFC < 14 CTFC > 40 0.0% (n=41) (n = 18/640) (n =35/563) 2.8% p= 0.003 “TIMI 4” Flow TIMI 3 Flow 14 < CTFC < 40 6.2% % Risk of In Hospital

Beyond TIMI 3 FlowBeyond TIMI 3 FlowBeyond TIMI 3 FlowBeyond TIMI 3 Flow

0

1

2

3

4

5

6

7

CTFC < 14CTFC < 14 CTFC > 40CTFC > 40

0.0%0.0%

(n=41)(n=41) (n = 18/640)(n = 18/640) (n =35/563)(n =35/563)

2.8%2.8%

p= 0.003p= 0.003

“TIMI 4” Flow“TIMI 4” Flow TIMI 3 FlowTIMI 3 Flow

14 < CTFC < 4014 < CTFC < 40

6.2%6.2%%

Ris

k o

f In

Ho

spit

al M

ort

alit

y

Gibson, Circulation 1999; 99: 1945-1950Gibson, Circulation 1999; 99: 1945-1950Hyperemic FlowHyperemic Flow

Reproducibility: r = 0.97 between readers

Accuracy:r=0.88 vs Doppler velocity

Reproducibility: r = 0.97 between readers

Accuracy:r=0.88 vs Doppler velocity

21

0

10

15

5

TIMI Myocardial Perfusion (TMP) Grades TIMI Myocardial Perfusion (TMP) Grades TIMI Myocardial Perfusion (TMP) Grades TIMI Myocardial Perfusion (TMP) Grades

0

1

2

3

4

5

6

7

8

6.2%6.2%

4.4%4.4%

2.0%2.0%n = 203n = 203 n = 46n = 46 n = 434n = 434

TMP Grade 3 TMP Grade 3

p = 0.05p = 0.05

Mo

r ta l

ity

( %)

Mo

r ta l

ity

( %)

n = 79n = 79

5.1%5.1%

Gibson et al, Circulation 2000Gibson et al, Circulation 2000

Normal ground glassappearance of blushDye mildly persistent

at end of washout

Normal ground glassappearance of blushDye mildly persistent

at end of washout

Dye strongly persistentat end of washout

Gone by next injection

Dye strongly persistentat end of washout

Gone by next injection

Stain presentBlush persists

on next injection

Stain presentBlush persists

on next injection

No or minimal blushNo or minimal blush

TMP Grade 2 TMP Grade 2 TMP Grade 1 TMP Grade 1 TMP Grade 0 TMP Grade 0

Not All TIMI Grade 3 Flow is Created Equally:Not All TIMI Grade 3 Flow is Created Equally:Not All TIMI Grade 3 Flow is Created Equally:Not All TIMI Grade 3 Flow is Created Equally:

0

1

2

3

4

5

6

Myocardial Perfusion Grade 3




Myocardial Perfusion Grades 0/1

Myocardial Perfusion Grades 0/1

N = 136N = 136 N = 34N = 34 N = 278N = 278

0.7%0.7%2.9%2.9%

5.4%5.4%

% M

ort

alit

y%

Mo

rtal

ity

P = 0.007P = 0.007

Gibson CM, et al. Circulation. 2000;101:125-130.Gibson CM, et al. Circulation. 2000;101:125-130.

Among Patients. With Successful Lysis, There is a 7 Fold Range in MortalityAmong Patients. With Successful Lysis, There is a 7 Fold Range in Mortality

TIMI 10 B: Independent Predictors of 2 Year MortalityTIMI 10 B: Independent Predictors of 2 Year MortalityTIMI 10 B: Independent Predictors of 2 Year MortalityTIMI 10 B: Independent Predictors of 2 Year Mortality

• TIMI Grade 3 Flow RR 0.61, p=0.047

• TIMI Myocardial Blush RR 0.50, p = 0.038

• TIMI Grade 3 Flow RR 0.61, p=0.047

• TIMI Myocardial Blush RR 0.50, p = 0.038

In a MV model correcting for :

Performance of PCI

Age

Gender

Pulse

Anterior MI

In a MV model correcting for :

Performance of PCI

Age

Gender

Pulse

Anterior MI

Pre-PCI Epicardial and Myocardial Flow Are Independently Associated with 2 Year Mortality

Gibson et al, Circulation 2002Gibson et al, Circulation 2002

p<0.0001

1.0

0.9

0.8

0.7

0.6

0.5 90 360 900 1440 2250 2790 90 360 900 1440 2250 2790

3

0/1

2

n=690

n=55

n=32

0/1

n=2362

n=393 3n=148

TIMI Flow Grades Myocardial Blush GradesSurvival

Time (days)

p<0.0001

van ‘t Hof AWJet al. Circulation 1998; 97:2302-6.van ‘t Hof AWJet al. Circulation 1998; 97:2302-6.

Myocardial Reperfusion ScoreMyocardial Reperfusion ScoreMyocardial Reperfusion ScoreMyocardial Reperfusion Score

Zwolle Myocardial Blush Grades(n=777)

A Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle System

TIMI Epicardial Flow Grade

TIMI Myocardial Perfusion Grade

Zwolle System

Grade 0 No flow No flow No flow

Grade 1 Penetrates but does not perfuse

Dye penetrates but is stuck in muscle

Very Pale

Grade 2 Slow flow in artery

Slow flow in muscle

Less Pale

Grade 3 Normal flow in artery

Normal flow in muscle


A Comparison of TMPG and Zwolle SystemA Comparison of TMPG and Zwolle SystemA Comparison of TMPG and Zwolle SystemA Comparison of TMPG and Zwolle System


Zwolle System

Grade 0 No flow No flow

Grade 1 Dye penetrates but is stuck in muscle

Very Pale

Grade 2 Slow flow in muscle

Less Pale

Grade 3 Normal flow in muscle


A Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle SystemA Comparison of TMPP and Zwolle System


Zwolle System

Grade 0 or 1 No flow = No flow

Grade 2 or 3 Normal or near normal = Normal or

near normal

Myocardial Perfusion After Primary PCI is Strongest Predictor of MortalityMyocardial Perfusion After Primary PCI is Strongest Predictor of MortalityMyocardial Perfusion After Primary PCI is Strongest Predictor of MortalityMyocardial Perfusion After Primary PCI is Strongest Predictor of Mortality

9090 360360 900900 14401440 22502250 27902790

0/1n=236

2n=393

3 n=148

Myocardial Blush GradesMyocardial Blush Grades

Time (days)Time (days)

8080

8585

9090

9595

33

22

0/10/1

100100

Cu

mu

lati

ve

Su

rviv

al

(%)

Cu

mu

lati

ve

Su

rviv

al

(%)

00 22 44 66 88 1010 12127575

Fin

al B

lus

h S

co

re (p

atie

nts

with

fina

l TIM

I gra

de

3 flo

w)

Fin

al B

lus

h S

co

re (p

atie

nts

with

fina

l TIM

I gra

de

3 flo

w)

Blush 1-Year MortalityBlush 1-Year Mortality

3322

0/10/1

6.8%6.8%13.2%13.2%18.3%18.3%

PP=0.004=0.004

RR* 95% CI P

MBG 0 and 1 vs 2 and 3 2.9 1.4 to 5.8 0.003

MVD 2 and 3 vs 1 2.3 1.1 to 4.7 0.02

LAD vs non-LAD MI 2.2 1.1 to 4.4 0.03

TIMI flow before: 0 to 2 vs 3 1.8 0.5 to 6.1 0.31

Independent Angiographic Variables as Risk Factors of Long-Term Independent Angiographic Variables as Risk Factors of Long-Term Mortality in Patients With TIMI Grade 3 flow After AngioplastyMortality in Patients With TIMI Grade 3 flow After Angioplasty

MBG 0/1(n=100)

MBG 2(n=74)

MBG 3(n=79) P

Death at 30 days

26.0% 9.9% 3.9% <0.001

Death at 1 year

35.1% 13.4% 9.4% <0.001

Death during F/U

39.0% 18.3% 12.4% <0.001

Relation of Myocardial Perfusion Grade to MortalityRelation of Myocardial Perfusion Grade to Mortality

2 of 3 pts have a closed muscle after 10 PCI

Mortality goes up 3 fold

2 of 3 pts have a closed muscle after 10 PCI

Mortality goes up 3 fold

Stone GW, et al. Stone GW, et al. J Am Coll Cardiol.J Am Coll Cardiol. 2002;39:591-597. 2002;39:591-597.

Haagar PK, et al. Haagar PK, et al. J Am Coll Cardiol.J Am Coll Cardiol. 2003;41:532-538 2003;41:532-538

Henriques JP, et al. Henriques JP, et al. Circulation.Circulation. 2003;107:2115-2119. 2003;107:2115-2119.

van ‘t Hof AWJet al. Circulation 1998; 97:2302-6.van ‘t Hof AWJet al. Circulation 1998; 97:2302-6.

Peak Myocardial Brightness, Circumference and Circumference Growth Peak Myocardial Brightness, Circumference and Circumference Growth in Culprit and Non-culprit Arteries in Acute MI and in Normal Patientsin Culprit and Non-culprit Arteries in Acute MI and in Normal Patients

Peak Myocardial Brightness, Circumference and Circumference Growth Peak Myocardial Brightness, Circumference and Circumference Growth in Culprit and Non-culprit Arteries in Acute MI and in Normal Patientsin Culprit and Non-culprit Arteries in Acute MI and in Normal Patients

9.6

6.15.4

0

2

4

6

8

10

12

9.6

6.15.4

0

2

4

6

8

10

12p < 0.0001p < 0.0001

NormalNormal Non-culprit AMINon-culprit AMI

DSA Peak Gray ScaleDSA Peak Gray Scale

Culprit AMICulprit AMI

p = NSp = NS19.6

12.9 12.9

0

5

10

15

20

25

19.6

12.9 12.9

0

5

10

15

20

25p < 0.0001p < 0.0001

p = NSp = NS5

3.73.3

0

1

2

3

4

5

6

5

3.73.3

0

1

2

3

4

5

6

p < 0.0001p < 0.0001

(cm

/sec

)(c

m/s

ec)

p = 0.02p = 0.02

Peak CircumferencePeak Circumference Peak Circumference GrowthPeak Circumference Growth

(cm

)(c

m)

n=65n=65 n=290n=290 n=161n=161 n=88n=88 n=377n=377 n=187n=187 n=85n=85 n=305n=305 n=182n=182

Murphy SA, Am J Cardiol 2003Murphy SA, Am J Cardiol 2003

Early Impaired Myocardial Perfusion is Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct SizeAssociated with Larger SPECT Infarct Size

Early Impaired Myocardial Perfusion is Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct SizeAssociated with Larger SPECT Infarct Size

0

2

4

6

8

10

12

14

16

0

2

4

6

8

10

12

14

16

Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts.

In a multivariate model, both impaired TMPG and incomplete ST resolution were independently associated with larger infarct size

Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts.

In a multivariate model, both impaired TMPG and incomplete ST resolution were independently associated with larger infarct size n=209n=209 n=111n=111

p<0.001p<0.001

0

2

4

6

8

10

12

14

0

2

4

6

8

10

12

14 Median = 13Median = 13

TMPGTMPG ST ResolutionST Resolution

p=0.004p=0.004

Res <70%Res <70% Res >70%Res >70%TMPG 0/1TMPG 0/1 TMPG 2/3TMPG 2/3

n=108n=108 n=113n=113

Median = 7Median = 7



% S

PE

CT

In

farc

t S

ize

Circulation 2002Circulation 2002

-25

-20

-15

-10

-5

0

5

-25

-20

-15

-10

-5

0

5

Red

uctio

n in

Pla

que

Vol

ume

(mm

3 )R

educ

tion

in P

laqu

e V

olum

e (m

m3 )

TMPG 3

Mortality 0%

TMPG 3

Mortality 0%

TMPG 0-2

Mortality 22%

TMPG 0-2

Mortality 22% P=0.077 for mortalityP=0.077

for mortality

P=0.0039P=0.0039

Greater Reduction in Plaque Area on IVUS is Associated with Greater Reduction in Plaque Area on IVUS is Associated with Impaired TIMI Myocardial Perfusion Grades (TMPG 0-2) in STEMIImpaired TIMI Myocardial Perfusion Grades (TMPG 0-2) in STEMI

Greater Reduction in Plaque Area on IVUS is Associated with Greater Reduction in Plaque Area on IVUS is Associated with Impaired TIMI Myocardial Perfusion Grades (TMPG 0-2) in STEMIImpaired TIMI Myocardial Perfusion Grades (TMPG 0-2) in STEMI

Kotani J,Mintz GS,Pregowski J et al for Wash Hosp Ctr, Am J Cardiol 2003; 92:728–732.Kotani J,Mintz GS,Pregowski J et al for Wash Hosp Ctr, Am J Cardiol 2003; 92:728–732.

N=17N=17

N=18N=18

Multivariate analysis indicated that the strongest predictor of a closed myocardium (TMPG 0-2) after primary PCI was a greater reduction in plaque volume on IVUS

Multivariate analysis indicated that the strongest predictor of a closed myocardium (TMPG 0-2) after primary PCI was a greater reduction in plaque volume on IVUS

22

31

0

5

10

15

20

25

30

35

22

31

0

5

10

15

20

25

30

35 66

36

0

10

20

30

40

50

60

70 66

36

0

10

20

30

40

50

60

70

FilterWire-ExFilterWire-Ex as an Adjunct to Primary PCIas an Adjunct to Primary PCI

Corrected TIMI Frame Count

p=0.005

Corrected TIMI Frame Count

p=0.005

TIM

I F

ram

e C

ou

nt

TIM

I F

ram

e C

ou

nt

MyocardialBlush Grade 3

p=0.006

MyocardialBlush Grade 3

p=0.006

Circulation 2003; 108:171-176Circulation 2003; 108:171-176

Design:Compared use of the FilterWire-Ex (FW) distal embolic protection device as an adjunct to primary PCI (n=53) vs matched control (n=53) in patients with acute MI.

Results• FW successfully positioned in 89% patients without complication• FW use remained only independent predictor of ST-segment resolution (OR 0.18, 95% CI 0.06-0.56, p=0.003) and myocardial blush grade 3 (OR 0.33, 95% CI 0.13-0.81, p=0.01)• All 13 filters that underwent histological analysis contained multiple embolic debris• No difference in 30 day MACE rates (5% for FW vs 11% for controls, p=0.488)

Design:Compared use of the FilterWire-Ex (FW) distal embolic protection device as an adjunct to primary PCI (n=53) vs matched control (n=53) in patients with acute MI.

Results• FW successfully positioned in 89% patients without complication• FW use remained only independent predictor of ST-segment resolution (OR 0.18, 95% CI 0.06-0.56, p=0.003) and myocardial blush grade 3 (OR 0.33, 95% CI 0.13-0.81, p=0.01)• All 13 filters that underwent histological analysis contained multiple embolic debris• No difference in 30 day MACE rates (5% for FW vs 11% for controls, p=0.488)

Filter WireFilter Wire Control Control

%

80

54

0

20

40

60

80

100

80

54

0

20

40

60

80

100

ST-segmentResolution

p=0.006

ST-segmentResolution

p=0.006

%

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

Co

ron

ary

Flo

w R

eser

veC

oro

nar

y F

low

Res

erve

AntithrombinAntithrombin Antithrombin

+ Eptifibatide

Antithrombin

+ Eptifibatide

1.28 + 0.41.28 + 0.4

1.78 + 0.951.78 + 0.95

N=27N=27 N=16N=16

P=0.02P=0.02

00

Gra

y p

er s

ecG

ray

per

sec

7.30 + 8.137.30 + 8.13

3.97 + 2.463.97 + 2.46

P=0.05P=0.05

N=27N=27 N=18N=18

Coronary Flow ReserveCoronary Flow Reserve Rate of Increase in DSA

Brightness (Gray /sec)

Rate of Increase in DSA

Brightness (Gray /sec)

5

10

5

10

Cir

cum

fere

nce

(cm

)C

ircu

mfe

ren

ce (

cm)

N=24N=24N=32N=32

7.2+ 3.27.2+ 3.2

8.5 + 4.08.5 + 4.0P=0.18P=0.18

Rate of Growth in

Blush Circumference

(cm / sec)

Rate of Growth in

Blush Circumference

(cm / sec)

ESPRIT Substudy: ResultsESPRIT Substudy: ResultsESPRIT Substudy: ResultsESPRIT Substudy: ResultsAll Patients Have TIMI Grade 3 Flow at Completion of Stenting & Antithrombin TreatmentAll Patients Have TIMI Grade 3 Flow at Completion of Stenting & Antithrombin Treatment


+ Eptifibatide

Antithrombin

+ Eptifibatide


+ Eptifibatide

Antithrombin

+ Eptifibatide

Gibson CM et al, Am J Cardiol 2001;87(11):1293-5.Gibson CM et al, Am J Cardiol 2001;87(11):1293-5.

TMPG and Maximum CK-MB 24 Hours Post-stentTMPG and Maximum CK-MB 24 Hours Post-stent

0

5

10

15

20

25

30

35

40

45

Open Muscle Closed Muscle

0

5

10

15

20

25

30

35

40

45


Max

imu

m C

K-M

B >

2x U

LN

(%

)M

axim

um

CK

-MB

>2x

UL

N (

%)

41.2%41.2%p = 0.002p = 0.002

1/24 14/34

4.2%4.2%

All Patients Have TIMI 3 Flow at Completion of StentingAll Patients Have TIMI 3 Flow at Completion of Stenting

Gibson CM et al, Am Heart J. 2002 Jan;143(1):106-110.Gibson CM et al, Am Heart J. 2002 Jan;143(1):106-110.

Stain Stain

Slow Slow

Pale Pale Normal Normal

TMPG Post-stent and Composite Events by 48 Hrs & 1 YrTMPG Post-stent and Composite Events by 48 Hrs & 1 YrTMPG Post-stent and Composite Events by 48 Hrs & 1 YrTMPG Post-stent and Composite Events by 48 Hrs & 1 Yr

0

5

10

15

20

25

30

35


0

5

10

15

20

25

30

35


Co

mp

osi

te E

ven

t (%

)C

om

po

site

Eve

nt

(%)

1 Year Death, MI, Urgent TVR1 Year Death, MI, Urgent TVR

p = 0.01p = 0.0132.4%32.4%

4.2%4.2%

1/241/24 11/3411/34

All Patients Have TIMI 3 Flow at Completion of StentingAll Patients Have TIMI 3 Flow at Completion of Stenting

Stain Stain

Slow Slow

Pale Pale Normal Normal

Gibson CM et al, Am Heart J. 2002 Jan;143(1):106-110.Gibson CM et al, Am Heart J. 2002 Jan;143(1):106-110.

A A DDecline in TMPG after Stenting is Associated with Larger Infarct Sizesecline in TMPG after Stenting is Associated with Larger Infarct SizesA A DDecline in TMPG after Stenting is Associated with Larger Infarct Sizesecline in TMPG after Stenting is Associated with Larger Infarct Sizes

Ricciardi, Gibson et al, CCD 2004Ricciardi, Gibson et al, CCD 2004Ricciardi, Gibson et al, CCD 2004Ricciardi, Gibson et al, CCD 2004

All patients had normal epicardial TIMI Grade 3 Flow before PCI

12 of 14 patients had normal TMPG 3 before PCI

Only 7 of 14 had normal TMPG 3 after PCI

All patients had normal epicardial TIMI Grade 3 Flow before PCI

12 of 14 patients had normal TMPG 3 before PCI

Only 7 of 14 had normal TMPG 3 after PCI

CK-MB p=0.01CK-MB p=0.01HE mass p=0.04HE mass p=0.04

NoNo YesYes00

1010

2020

3030

4040

5050

00

11

22

33

44

Decline in post-stent TMPGDecline in post-stent TMPGH

E m

ass

(gm

)H

E m

ass

(gm

)

CK

-MB

(ng

/dL)

CK

-MB

(ng

/dL)

==Ramondo et al,Catheter Cardiovasc Interv 2004;61:222–226.Ramondo et al,Catheter Cardiovasc Interv 2004;61:222–226.

0.31

0.5

0

0.1

0.2

0.3

0.4

0.5

0.6

0.31

0.5

0

0.1

0.2

0.3

0.4

0.5

0.6

4.5

7.9

0

1

2

3

4

5

6

7

8

9

4.5

7.9

0

1

2

3

4

5

6

7

8

9

Tn

I (n

g /

mL

)T

n I

(ng

/ m

L)

tn T

(n

g /

mL

)tn

T (

ng

/ m

L)

TMPG 0/1TMPG 0/1TMPG 2/3TMPG 2/3

P=0.006P=0.006 P=0.007P=0.007

TMPG 2/3TMPG 2/3 TMPG 0/1TMPG 0/1

Peak [tnT] and [tnI] by TIMI Myocardial Perfusion Grade (TMPG) status

Peak [tnT] and [tnI] by TIMI Myocardial Perfusion Grade (TMPG) status

Circulation 2002;106:202-207Circulation 2002;106:202-207

55.4

35.6

0

10

20

30

40

50

60

cTnT+ cTnT-

55.4

35.6

0

10

20

30

40

50

60

cTnT+ cTnT-

54.1

36.7

0

10

20

30

40

50

60

cTnI+ cTnI-

54.1

36.7

0

10

20

30

40

50

60

cTnI+ cTnI-

Troponin Elevations on Admission are Associated with Tissue Level Perfusion Following PCI: TACTICS TIMI 18


p=0.004p=0.004 p=0.013p=0.013

% T

MP

G 0

/1%

TM

PG

0/1

% T

MP

G 0

/1%

TM

PG

0/1


Troponin T & Angiographic FindingsTroponin T & Angiographic FindingsTroponin T & Angiographic FindingsTroponin T & Angiographic Findings

29.3

42.5

0

5

10

15

20

25

30

35

40

45

29.3

42.5

0

5

10

15

20

25

30

35

40

45

64.8

72

60

62

64

66

68

70

72

74

64.8

72

60

62

64

66

68

70

72

74

7

15.6

0

2

4

6

8

10

12

14

16

18

7

15.6

0

2

4

6

8

10

12

14

16

18

42.1

58.1

0

10

20

30

40

50

60

70

42.1

58.1

0

10

20

30

40

50

60

70

% S

ten

osi

s%

Ste

no

sis

% V

esse

l Occ

lusi

on

% V

esse

l Occ

lusi

on

% N

orm

al T

MP

G 3

% N

orm

al T

MP

G 3

% T

hro

mb

us

% T

hro

mb

us

tnT +tnT + tnT +tnT + tnT +tnT +tnT +tnT +tnT -tnT - tnT -tnT - tnT -tnT - tnT -tnT -

P=0.021P=0.021

P=0.0003P=0.0003 P=0.03P=0.03

P=0.007P=0.007

Even when epicardial TIMI flow grade and the presence of thrombus were adjusted for, the presence of a closed microvasculature was independently associated with tnT elevation in a multivariate model (O.R. 1.79, p=0.017).

Even when epicardial TIMI flow grade and the presence of thrombus were adjusted for, the presence of a closed microvasculature was independently associated with tnT elevation in a multivariate model (O.R. 1.79, p=0.017).


Event Free Survival is Associated with Tissue Level Perfusion in UA / Non Q Wave MI: TACTICS – TIMI 18

Event Free Survival is Associated with Tissue Level Perfusion in UA / Non Q Wave MI: TACTICS – TIMI 18


0.7

0.8

0.9

1

0 30 60 90 120 150 180

0.7

0.8

0.9

1

0 30 60 90 120 150 180

p=0.026p=0.026

DaysDays

Eve

nt

Fre

e S

urv

ival

Eve

nt

Fre

e S

urv

ival

TMPG 0/1 Pre &

Post PCI

TMPG 0/1 Pre &

Post PCI

TMPG 2/3 Pre or Post-PCI

TMPG 2/3 Pre or Post-PCI

Stain Stain

Slow Slow

Pale Pale

Normal Normal

29.6

41.9

25

30

35

40

45

29.6

41.9

25

30

35

40

45

N = 253 N = 253

% T

MP

G 3

% T

MP

G 3

P = 0.018P = 0.018

“Upstream”

Duration

(> median)

“Upstream”

Duration

(> median)

• Impaired tissue perfusion on diagnostic cath is associated with Tn + and adverse outcomes

• Earlier upstream initiation of GPIIbIIIa inhibition is associated with improved tisse perfusion om diagnostic cath

• Impaired tissue perfusion on diagnostic cath is associated with Tn + and adverse outcomes

• Earlier upstream initiation of GPIIbIIIa inhibition is associated with improved tisse perfusion om diagnostic cath

Gibson CM, AHA 2001Gibson CM, AHA 2001

55.4

35.6

0

10

20

30

40

50

60

cTnT+ cTnT-

55.4

35.6

0

10

20

30

40

50

60

cTnT+ cTnT-

54.1

36.7

0

10

20

30

40

50

60

cTnI+ cTnI-

54.1

36.7

0

10

20

30

40

50

60

cTnI+ cTnI-



p=0.004p=0.004 p=0.013p=0.013

% T

MP

G 0

/1%

TM

PG

0/1

% T

MP

G 0

/1%

TM

PG

0/1


Documents

Beyond TIMI 3 Flow CTFC < 14 CTFC > 40 0.0% (n=41) (n = 18/640) (n =35/563) 2.8% p= 0.003 “TIMI 4” Flow TIMI 3 Flow 14 < CTFC < 40 6.2% % Risk of In Hospital