Patients with TIMI flow grade 3 show improved regional and global left ventricular function, lower enzyme peaks, and reduced morbidity and mortality rates compared with patients with TIMI flow grades 0, 1, or 2. 10 However, more recent studies 7 have identified a disparity with regard to clinical outcomes after thrombolysis when patients are stratified between TIMI flow grades ≤2 and TIMI grade 3. 3 4 5 6 7 8 9 In early analyses, both TIMI flow grades 2 and 3 were considered indicative of successful reperfusion. 1 2 Determination of TIMI flow grade after coronary reperfusion yields important prognostic information in patients with acute myocardial infarction.

The TIMI flow grade has become the standard for semiquantitative evaluation of myocardial perfusion before and after coronary reperfusion therapies. The Thrombolysis In Myocardial Infarction (TIMI) study group developed a grading scale for coronary blood flow based on visual assessment of the rate of contrast opacification of the infarct artery. Nine of 11 clinical events (unstable angina and coronary artery bypass graft surgery) occurred in patients with low coronary flow velocity.Ĭonclusions Determination of flow velocity after reperfusion may enhance patient characterization and provide the physiological rationale for clinical variations after reperfusion therapy. Although post-PTCA flow velocity correlated with angiographic cineframes-to-opacification count ( r=.45 P<.02) for TIMI grade 3, there was a large overlap with TIMI grades ≤2 that had low flow velocity (<20 cm/s). TIMI grade 3 flow increased to 21.8☑0.9 cm/s ( P<.05 versus before PTCA). Poststenotic flow velocity increased from 6.6☖.1 to 20.0☑1.1 cm/s ( P<.01). After PTCA, 1 patient had TIMI grade 1, 5 had TIMI 2, and 35 had TIMI 3 flow. Flow velocity was similar among patients with TIMI grades 0, 1, or 2 but was lower than in those with TIMI grade 3 flow (9.4±5.4 versus 16.0±5.4 cm/s for TIMI grades ≤2 versus TIMI grade 3, respectively P<.05). Before PTCA, 34 patients had TIMI grade 0 or 1, 5 had TIMI grade 2, and 2 had TIMI grade 3 flow in the infarct artery. Methods and Results Coronary flow velocity (measured by use of a Doppler guidewire) during primary or rescue PTCA in 41 acute myocardial infarction patients was compared with TIMI grade and cineframes-to-opacification count. However, intracoronary blood flow velocity has not been compared with the angiographic method of determining flow grade in patients. Different TIMI angiographic flow grades (flow grades based on results of the Thrombolysis In Myocardial Infarction trial) have been associated with different clinical results after reperfusion for acute myocardial infarction. Customer Service and Ordering Informationīackground This study compared angiographically graded coronary blood flow with intracoronary Doppler flow velocity in patients during percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).These results suggest TIMI grade 2 flow at 45 min after thrombolysis followed by immediate PCI, as well as TIMI grade 3 flow, is associated with greater myocardial salvage than TIMI grade 0 or 1 flow. Although the door-to-balloon times did not differ in groups T0 and T2, group T2 had lower peak creatine kinase, a higher rate of complete (≥70%) ST resolution and better regional wall motion at discharge as compared with group T0, similar to group T3 (group T2, group T3 vs group T0 2,857☑,756, 2,314☑,948 vs 3,779 ☒,214 mU/ml 57, 72 vs 34% -1.5☑.6, -1.2☑.6 vs -2.2☑.6 all p<0.01, respectively). Patients were classified into 3 groups according to TIMI grade flow 45 min after thrombolysis 38 patients with TIMI grade 0 or 1 flow (group T0) and 46 with TIMI grade 2 flow (group T2) additionally received immediate percutaneous coronary intervention (PCI) and 50 patients with TIMI grade 3 flow (group T3) were treated conservatively after thrombolysis. Although pre-interventional thrombolysis has recently been shown to restore early patency and preserve left ventricular function in patients with acute myocardial infarction, the significance of Thrombolysis in Myocardial Infarction (TIMI) grade flow early after thrombolysis remains unclear.

Timi 1 flow