Pattern of TIMI Flow in Late Arrival STEMI its impact on mortality and Factors that Predict the TIMI ≥ II in Patients with Late Arrival Pattern of TIMI

Abstract

Background: Acute ST Elevation Myocardial Infarction has high mortality but timely reperfusion is related to improved LV function and improved mortality. Clinical trials demonstrated decreased infarct size and improved mortality in late-arrival STEMI patients. However a significant number of these late arrival patients had TIMI flow ≥II at the baseline. We performed a study to observe the prevalence of Pre-procedure TIMI ≥II flow, its predictors and its impact on In-hospital mortality.

Methodology: It was a two-center observational study conducted at the National Institute of Cardiovascular Disease and its satellite from November 2022 to September 2023. Late-arrival STEMI patients who presented >12 hours after symptoms onset and had undergone cardiac catheterization were included. The baseline TIMI flow in the culprit artery was noted. The patients were followed until discharge.

Results: A total of 305 patients were included in the study. Hypertension was the most prevalent risk factor in 50% (153) followed by diabetes in 34% (104). The prevalence of TIMI ≥II flow was present in 24.6% (75). There was no significant difference for in-hospital mortality between patients with baseline TIMI-0/I or Baseline TIMI-≥II at baseline (7.0% vs. 6.7%). The presence of chest pain within 24 hours (OR: 2.2), and Killip class-II (OR: 2.99) at arrival were predictors associated with TIMI ≥II at baseline angiogram.

Conclusion: Chest pain within 24 hours and killip class-II at presentation were associated with open artery at baseline on angiogram. These factors may be considered for beneficial effect while choosing patients with late arrival STEMI for revascularization.