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Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion.

Publication ,  Journal Article
Giugliano, RP; Sabatine, MS; Gibson, CM; Roe, MT; Harrington, RA; Murphy, SA; Morrow, DA; Antman, EM; Braunwald, E
Published in: Am J Cardiol
June 1, 2004

The restoration of epicardial and myocardial flow remains the primary goal of reperfusion therapy in patients with ST-segment elevation myocardial infarction, but the optimal method to assess this goal has not been defined. Thrombolysis In Myocardial Infarction flow grade (TFG), myocardial perfusion grade (MPG), and ST-segment resolution (STRes) were combined to formulate a new measure of successful reperfusion in 649 patients who received pharmacologic reperfusion therapy in 3 recent phase II clinical trials of ST-segment elevation myocardial infarction. Coronary angiograms and electrocardiograms were analyzed at 60 minutes (before any intervention) after the initiation of reperfusion therapy. The complete restoration of perfusion, or the "trifecta," defined as the presence of TFG 3, MPG 3, and complete (> or =70%) STRes, occurred in 117 patients (18%). The achievement of this trifecta was associated with low rates of 30-day mortality (0% vs 3.9%, p = 0.02), congestive heart failure (CHF) (0.9% vs 7.1%, p = 0.01), and the combination of death or CHF (0.9% vs 10.7%, p = 0.001). When the results were stratified with respect to subsequent percutaneous coronary intervention (PCI) from 60 to 120 minutes, attainment of the trifecta at 60 minutes remained a strong predictor of better clinical outcomes, particularly in those patients who underwent early PCI. The achievement of TFG 3, MPG 3, and complete STRes at 60 minutes after fibrinolytic therapy and before PCI occurred in only 18% of patients but was associated with very low rates of death and CHF at 30 days. This new end point is proposed to evaluate the success of reperfusion therapy in patients who undergo early angiography.

Duke Scholars

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

June 1, 2004

Volume

93

Issue

11

Start / End Page

1362 / A6

Location

United States

Related Subject Headings

  • Tyrosine
  • Tissue Plasminogen Activator
  • Tirofiban
  • Time Factors
  • Thrombolytic Therapy
  • Tenecteplase
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Giugliano, R. P., Sabatine, M. S., Gibson, C. M., Roe, M. T., Harrington, R. A., Murphy, S. A., … Braunwald, E. (2004). Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion. Am J Cardiol, 93(11), 1362-A6. https://doi.org/10.1016/j.amjcard.2004.02.031
Giugliano, Robert P., Marc S. Sabatine, C Michael Gibson, Matthew T. Roe, Robert A. Harrington, Sabina A. Murphy, David A. Morrow, Elliott M. Antman, and Eugene Braunwald. “Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion.Am J Cardiol 93, no. 11 (June 1, 2004): 1362-A6. https://doi.org/10.1016/j.amjcard.2004.02.031.
Giugliano RP, Sabatine MS, Gibson CM, Roe MT, Harrington RA, Murphy SA, et al. Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion. Am J Cardiol. 2004 Jun 1;93(11):1362-A6.
Giugliano, Robert P., et al. “Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion.Am J Cardiol, vol. 93, no. 11, June 2004, pp. 1362-A6. Pubmed, doi:10.1016/j.amjcard.2004.02.031.
Giugliano RP, Sabatine MS, Gibson CM, Roe MT, Harrington RA, Murphy SA, Morrow DA, Antman EM, Braunwald E. Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion. Am J Cardiol. 2004 Jun 1;93(11):1362-A6.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

June 1, 2004

Volume

93

Issue

11

Start / End Page

1362 / A6

Location

United States

Related Subject Headings

  • Tyrosine
  • Tissue Plasminogen Activator
  • Tirofiban
  • Time Factors
  • Thrombolytic Therapy
  • Tenecteplase
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged