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Relationship between the door-to-TIMI-3 flow time and the infarct size in patients suffering from acute myocardial infarction: analysis based on the fibrinolysis and subsequent transluminal (FAST-3) trial.

Circulation journal : official journal of the Japanese Circulation Society

therapeutic use, Aged, Anticoagulants, Aspirin, administration & dosage, Biological Markers, Coronary Circulation, Creatine Kinase, blood, Creatine Kinase, MB Form, Drug Therapy, Combination, Electrocardiography, Emergency Service, Hospital, statistics & numerical data, Female, Fibrinolysis, Fibrinolytic Agents, Heparin, Hospitals, University, Humans, Isoenzymes, Japan, epidemiology, Male, Middle Aged, Myocardial Infarction, drug therapy, pathology, Myocardial Reperfusion, methods, Patient Admission, Plasminogen Activators, Prospective Studies, Recombinant Proteins, Risk Factors, Stroke Volume, Thrombolytic Therapy, Time Factors, Tissue Plasminogen Activator, Treatment Outcome, Troponin T, Urokinase-Type Plasminogen Activator

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      Abstract

      The purpose of this study was to use the findings of a fibrinolysis and subsequent transluminal trial (FAST-3) to evaluate the association between the target time for obtaining a thrombolysis in myocardial infarction (TIMI)-3 flow after arrival at the emergency room with acute myocardial infarction (AMI) and the degree of myocardial salvage. The FAST-3 trial was administered to 100 patients suffering from AMI. Ranges in the door-to-TIMI-3 flow time (D-T3-time: TIMI-3 flow after arrival at the emergency room) according to quartile were as follows: 30-54 min (quartile 1), 55-77 min (quartile 2), 78-120 min (quartile 3) and 121-330 min (quartile 4). Peak creatine kinase (CK), peak CK-MB, and peak troponin-T values increased in a stepwise fashion across the increasing quartiles of D-T3-time. The left ventricular end diastolic volume index at 30 days after the start of treatment showed low values for quartile 1. In multiple logistic regression analyses for independent predictors of myocardial damage, the adjusted odds ratios for myocardial damage (peak CK>3,000 U/L) in quartiles 3 and 4 of the D-T3-time were 4.0 (95% CI: 1.0-16.1) and 7.0 (95% confidence interval (CI): 1.4-36.0), respectively. These findings suggest that physicians should monitor the D-T3-time for at least 55 min.

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      15056821

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