1-3 The success of primary angioplasty is attributed to its ability to promptly restore optimal coronary flow (TIMI grade 3) after arterial recanalization, which is associated with a better immediate and mid-term prognosis. Primary angioplasty has proven to be the best therapeutic option for acute myocardial infarction (AMI), providing early, optimal reestablishment of coronary flow and resulting in a significant reduction in mortality as compared to thrombolytic treatment.
Los indicadores no invasivos de reperfusión coronaria debieran emplearse en forma complementaria a la angiografía en estos pacientes. Sin embargo, la reperfusión coronaria exitosa resultó ser un indicador de pronóstico independiente para la mortalidad intrahospitalaria y a medio plazo, el desarrollo de insuficiencia cardíaca y arritmias complejas. Se confirma que tanto el flujo TIMI 3 como la reperfusión coronaria exitosa evaluada a través de indicadores no invasivos tienen un valor pronóstico independiente en pacientes con IAM tratados con angioplastia primaria. Sin embargo, sólo la reperfusión exitosa resultó ser protectora frente a la insuficiencia cardíaca y las arritmias complejas en la evolución intrahospitalaria y en la mortalidad a medio plazo al ajustar por ambos criterios en el análisis multivariado. El objetivo es comparar el valor pronóstico del flujo TIMI 3 con la asociación de indicadores no invasivos de reperfusión coronaria (disminución del supradesnivel del segmento ST > 50% a los 90 min, inversión de la onda T dentro de las 24 h y elevación máxima de la creatincinasa 70%, valor máximo de CK) demostró que tanto la reperfusión exitosa como el flujo TIMI 3 resultaron ser protectores frente a la mortalidad intrahospitalaria (odds ratio = 0,028 intervalo de confianza del 95%, 0,003-0,268, y OR = 0,104 IC del 95%, 0,019-0,563, respectivamente). Tanto la obtención de un flujo coronario óptimo, grado TIMI 3, como la asociación de indicadores no invasivos de reperfusión coronaria han demostrado ser métodos útiles para predecir el pronóstico inmediato y a medio plazo de pacientes con IAM tratados con trombólisis o angioplastia primaria. La angioplastia primaria ha resultado ser el tratamiento más eficaz para pacientes con infarto agudo de miocardio (IAM). Noninvasive markers of coronary reperfusion should be used as complementary to angiography in these patients. Our findings confirm that both TIMI 3 flow and successful coronary reperfusion evaluated noninvasively show independent prognostic value in patients with AMI treated with primary angioplasty. However, in the multivariate analysis only successful reperfusion was a protective factor for heart failure and complex arrhythmias. 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. There was no significant concordance between the two methods (kappa index =0.012). Reperfusion was successful in 87.7% of the patients, and TIMI 3 flow was achieved in 87%.
The noninvasive criterion for successful reperfusion was the presence of two or more markers of reperfusion based on ECG changes or CK levels after angioplasty. In-hospital mortality was 3.6% 16.6% developed heart failure, and 11.1% had complex arrhythmias during their hospital stay. Mean age was 61☑3 years, 77% were men, and 56% had a history of previous AMI. We analyzed 172 consecutive patients with AMI and ST-segment elevation, who were treated with primary angioplasty within 12 hours of admission. The aim of this study was to compare the prognostic value of TIMI 3 flow versus noninvasive markers of coronary artery reperfusion on the outcome of patients with a recent acute myocardial infarction (AMI) treated with primary angioplasty.
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