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      Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention

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          Abstract

          Background:

          Myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) and corrected TIMI frame count (cTFC) are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

          Materials and Methods:

          A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3.

          Results:

          The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3) was positively associated with a history of nitrate intake ( P = 0.03) and history of calcium channel blocker (CCB) intake ( P = 0.005). Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames ( r = −0.32, P = 0.001).

          Conclusions:

          Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.

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          Most cited references40

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          TIMI frame count: a quantitative method of assessing coronary artery flow.

          Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature. In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7 +/- 3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2 +/- 2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4 +/- 3.0) and circumflex counts (22.2 +/- 4.1, P < .001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2 +/- 20.0 frames, which improved to 31.7 +/- 12.9 frames by 18 to 36 hours (P < .001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5 +/- 9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0 +/- 3.1, P < .001) but improved to that of normal arteries by 1 day after thrombolysis (21.7 +/- 7.1, P=NS). The CTFC is a simple, reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
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            2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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              The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group.

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                Author and article information

                Journal
                Adv Biomed Res
                Adv Biomed Res
                ABR
                Advanced Biomedical Research
                Medknow Publications & Media Pvt Ltd (India )
                2277-9175
                2277-9175
                2014
                04 September 2014
                : 3
                : 186
                Affiliations
                [1 ]Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
                [2 ]Students Research Committee, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
                [3 ]Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
                [4 ]Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
                [5 ]Kermanshah University of Medical Sciences, Kermanshah, Iran
                [6 ]Department of pharmacology, Applid Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [7 ]Department of Radiology, Tabriz University of Medical Science, Tabriz, Iran
                Author notes
                Address for correspondence: Dr. Azita Hajhossein Talasaz, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O. Box 14155/6451, Tehran 1417614411, Iran. E-mail: atalasaz@ 123456razi.tums.ac.ir
                Article
                ABR-3-186
                10.4103/2277-9175.140096
                4166209
                25250300
                80ff207d-443e-4f97-9985-cb6d8bab61d3
                Copyright: © 2014 Eshraghi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 June 2013
                : 08 September 2013
                Categories
                Original Article

                Molecular medicine
                corrected thrombolysis in myocardial infarction frame count,myocardial blush grade,outcome,risk factor,thrombolysis in myocardial infarction flow

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