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Is PCI necessary for AMI related artery with TIMI 3 flow ?

Is PCI necessary for AMI related artery with TIMI 3 flow ?. Donghoon Choi Yonsei Cardiovascular Center Yonsei University College of Medicine. M/63. Chest pain of 1 hour. Coronary Angiography. What do you think the fate of m-LAD after primary PCI will be ?.

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Is PCI necessary for AMI related artery with TIMI 3 flow ?

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  1. Is PCI necessary for AMI related artery with TIMI 3 flow ? Donghoon Choi Yonsei Cardiovascular Center Yonsei University College of Medicine

  2. M/63 Chest pain of 1 hour

  3. Coronary Angiography

  4. What do you thinkthe fate of m-LAD after primary PCI will be ?

  5. Primary PTCA VS Thrombolysis PTCA Thrombolysis * (%) 100 * p<0.001 80 60 40 * * * * 20 0 TIMI 3 Flow Death Death or MI CVA ICH Weaver WD et al. JAMA 1997;278:2093

  6. TIMI Flow Grades at Initial Angiography % patients n=2507 Stone GW et al. Circulation 2001;104:636

  7. Survival after Primary PTCA in AMI by Initial TIMI Flow TIMI 3 TIMI 2 TIMI 0/1 Stone GW et al. Circulation 2001;104:636

  8. Final TIMI Flow after Primary PCI and 30-day Mortality in AMI GUSTO IIb NEJM 1997;336:1621

  9. Final TIMI 3 Flow !!!

  10. Primary PCI M/63 Pre Post ballon angioplasty

  11. Primary PCI M/63 Post stenting (GFX 3.0 x 24) After IC Verapmil

  12. Pathophysiology of AMI Ruptured fibrous cap with thrombus

  13. Embolized Platelet Aggregate in a Small Myocardial Arteriole

  14. Likelihood of Distal Embolization less less Spontaneous reperfusion (endogenous thrombolysis) Thrombolytic therapy PTCA Stenting more more

  15. STENT- PAMI 6 month mortality Final TIMI 3 flow p=0.27 p=0.10 Grines CL et al. NEJM 1999;341:1949

  16. Final TIMI Flow in Relation to Initial TIMI Flow TIMI 3 TIMI 0, 1, 2 Final TIMI Flow : Pre TIMI 0,1 (n = 649) Pre TIMI 2 (n = 166) Pre TIMI 3 (n = 76) Cura et al. JACC 2001;88:124

  17. Impact of Stenting on Coronary Blood Flow after Balloon angioplasty in Primary PCI patients based on frame count Escobar et al. AJC 2001;88:1410

  18. Effects of Adjuvant Balloon on CT-Frame Count 43.5% % of total pts • Increased CTFC • : 20 pts(43.5%) • Decreased CTFC • : 15 pts(32.6%) • No change in CTFC • : 11pts(23.9%) 32.6% 23.9% Change in CTFC Koo BG et al. Korean Circulation in Press

  19. TIMI 3 Flow !!!

  20. Survival by Initial and Final Procedural TIMI flow TIMI Flow N (%) 6 month prepostpatientsmortality 3 3 368(15.8%) 0% 0~2 3 1,786(76.8%) 3.6% 0~2 0~2 166 (7.1%) 8.6% 3 0~2 7 (0.3%) 20.0% 100% 95% 90% 85% 80% 75% 0 30 60 90 120 150 180 Stone GW et al. Circulation 2001;104:636

  21. CADILLAC P = NS Stone GW et al. NEJM 2002;346:957

  22. Conclusion Primary PCI can harm coronary blood flow in AMI. Therefore, PCI is neccesary only in AMI with impaired initial coronary perfusion.

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