Implications of pre-procedural TIMI flow in patients with non ST-segment elevation acute coronary syndromes undergoing percutaneous coronary revascularization: Insights from the ACUITY trial

ObjectivesThe purpose of this study was to evaluate the prognostic implications of preprocedural TIMI flow in ACS patients undergoing early invasive management.BackgroundAlthough the negative prognostic impact of reduced Thrombolysis in Myocardial Infarction (TIMI) flow before percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) has been well described, whether this relationship holds in patients with acute coronary syndromes (ACS; unstable angina and non-STEMI) has not been examined.MethodsWe evaluated 3582 moderate and high-risk patients with ACS undergoing PCI enrolled in the ACUITY trial. Patients were divided in 3 groups according to pre-procedural culprit vessel TIMI flow (TIMI 0/1, TIMI 2 and TIMI 3 flows), determined by an independent angiographic core laboratory.ResultsBaseline culprit vessel flow was absent (TIMI 0/1) in 453 patients (12.6%), reduced (TIMI 2) in 389 patients (10.9%) and normal (TIMI 3) in 2740 patients (76.5%) patients. Post-PCI TIMI 3 flow was achieved in 87.2%, 86.8% and 98.8% of the 3 groups, respectively (P < 0.0001). At 1 year, mortality occurred in 2.7%, 2.4% and 3.0% of patients with baseline TIMI 0/1, 2 and 3 flows, respectively (P = 0.82). By multivariable analysis, pre-PCI TIMI flow 0/1 (vs. TIMI 3) was not an independent predictor of 1-year mortality (P = 0.61).ConclusionsReduced baseline TIMI flow in moderate and high-risk patients with ACS undergoing PCI does not appear to affect survival at 1 year, in contrast to that described in patients with STEMI.