Abstract | AIMS: The aim of this study was to determine the prognostic impact of pre- and post-PCI TIMI flow grade and TIMI myocardial perfusion grade ( TMPG) in a well-defined group of patients with cardiogenic shock due to acute myocardial infarction. METHODS AND RESULTS: Patients with infarct-related cardiogenic shock randomised into the CULPRIT- SHOCK trial were included in the angiographic predictor analysis whenever their TIMI flow grade or TMPG was available in the core lab database (96.9% of cases). A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate whether TIMI flow grade or TMPG was independently associated with all-cause mortality or renal replacement therapy up to one year. Pre-PCI TIMI flow grade and TMPG did not impact on mortality. When analysed in separate multivariable models, post-PCI TIMI 3 flow and TMPG grade 3 were both significantly associated with reduced risk of 30-day mortality: aOR 0.61 (95% CI: 0.38-0.97, p=0.037) and 0.46 (95% CI: 0.29-0.72, p<0.001), respectively. When considered in the same multivariable model, only TMPG was significantly associated with 30-day mortality (aOR 0.38 [0.20-0.71], p=0.002), the 30-day composite of all-cause mortality and renal replacement therapy (aOR 0.34 [0.18-0.66], p=0.001) and mortality at one-year follow-up (aOR 0.46 [0.24-0.88], p=0.02). CONCLUSIONS: Post-PCI TIMI flow grade and TMPG are associated with mortality after PCI. TMPG is a better discriminator, supporting microcirculation rather than epicardial reperfusion for prognosis estimation.
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Authors | Pavel Overtchouk, Olvier Barthélémy, Marie Hauguel-Moreau, Paul Guedeney, Stéphanie Rouanet, Michel Zeitouni, Johanne Silvain, Jean-Philippe Collet, Eric Vicaut, Uwe Zeymer, Steffen Desch, Holger Thiele, Gilles Montalescot, Collaborators |
Journal | EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
(EuroIntervention)
Vol. 16
Issue 15
Pg. e1237-e1244
(02 05 2021)
ISSN: 1969-6213 [Electronic] France |
PMID | 32624460
(Publication Type: Journal Article, Randomized Controlled Trial)
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Topics |
- Coronary Angiography
- Humans
- Myocardial Infarction
(complications, diagnostic imaging, therapy)
- Percutaneous Coronary Intervention
- Shock, Cardiogenic
(etiology, therapy)
- Treatment Outcome
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