Angiographic predictors of reocclusion after thrombolysis: Results from the thrombolysis in myocardial infarction (TIMI) 4 trial

C. Michael Gibson, Christopher P. Cannon, Robert N. Piana, Jeffrey A. Breall, Barry Sharaf, Margaret Flatley, Barbara Alexander, Daniel J. Diver, Carolyn H. McCabe, Greg C. Flaker, Donald S. Baim, Eugene Braunwald

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Objectives.: This study attempted to determine which lesion characteristics are associated with reocclusion by 18 to 36 h. Background.: Reocclusion of the infarct-related artery after successful reperfusion is associated with significant morbidity and up to a threefold increase in mortality. Methods.: Two hundred seventy-eight patients with acute myocardial infarction were randomized to receive either anisoylated plasminogen streptokinase activator complex (APSAC) or recombinant tissue-type plasminogen activator (rt-PA) or their combination. Culprit arteries were assessed for Thrombolysis in Myocardial Infarction (TIMI) flow grade, lesion ulceration, thrombus, collateral circulation and eccentricity. Minimal lumen diameter, percent diameter stenosis and lesion irregularity (power) were calculated using quantitative angiography. Results.: Reocclusion was observed more frequently in arteries with TIMI 2 versus TIMI 3 flow (10.4% vs. 2.2%, p = 0.003), in ulcerated lesions (10.7% vs. 3.0%, p = 0.009) and in the presence of collateral vessels (18.2% vs. 5.6%, p = 0.03). Similar trends were observed for eccentric (7.3% vs. 2.3%, p = 0.06) and thrombotic (8.4% vs. 3.3%, p = 0.06) lesions. Reocclusion was associated with more severe mean percent stenosis (77.9% vs. 73.9%, p = 0.04). Lesion length, reference segment diameter and Fourier measures of lesion irregularity were not associated with reocclusion. Conclusions.: Several simply assessed angiographic variables, such as the presence of TIMI grade 2 flow, ulceration, collateral vessels and greater percent diameter stenosis at 90 min after thrombolytic therapy, are associated with significantly higher rates of infarct-related artery reocclusion by 18 to 36 h and may aid in identifying the subset of patients who are at significantly higher risk of early reocclusion and who potentially warrant further early pharmacologic or mechanical intervention.

Original languageEnglish (US)
Pages (from-to)582-589
Number of pages8
JournalJournal of the American College of Cardiology
Volume25
Issue number3
DOIs
StatePublished - Mar 1 1995
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Angiographic predictors of reocclusion after thrombolysis: Results from the thrombolysis in myocardial infarction (TIMI) 4 trial'. Together they form a unique fingerprint.

  • Cite this

    Gibson, C. M., Cannon, C. P., Piana, R. N., Breall, J. A., Sharaf, B., Flatley, M., Alexander, B., Diver, D. J., McCabe, C. H., Flaker, G. C., Baim, D. S., & Braunwald, E. (1995). Angiographic predictors of reocclusion after thrombolysis: Results from the thrombolysis in myocardial infarction (TIMI) 4 trial. Journal of the American College of Cardiology, 25(3), 582-589. https://doi.org/10.1016/0735-1097(94)00423-N