To determine the prognostic impact of pre and post-PCI TIMI Flow Grade (TIMI) and TIMI Myocardial Perfusion (TMPG) in a well-defined group of patients with cardiogenic shock due to acute myocardial infarction.
Methods and results :
Patients with infarct-related cardiogenic shock randomized into the CULPRIT-SHOCK trial were included in the angiographic predictor analysis whenever their TIMI or TMPG was available in the Corelab database (96.9% of cases). A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate if TIMI or TMPG, were independently associated with all-cause mortality or renal replacement therapy up to 1 year. Pre-PCI TIMI and TMPG did not impact mortality. When analyzed in separate multivariable models, post-PCI TIMI 3 and TMPG grade 3 were both significantly associated with reduced risk of 30-day mortality: aOR 0.61 (95%CI: 0.38-0.97, p=0.037) and 0.46 (95%CI: 0.29-0.72, p<0.001), respectively. When considered in the same multivariable model, only TMPG was significantly associated with 30-day mortality (aOR 0.38 [0.20-0.71], p=0.002), 30-day composite of all-cause mortality and renal replacement therapy (aOR 0.34 [0.18-0.66], p=0.001) and mortality at 1-year follow-up (aOR 0.46 [0.24-0.88], p=0.02).
Post-PCI TIMI and TMPG are associated with mortality after PCI. TMPG is a better discriminator, supporting microcirculation rather than epicardial reperfusion for prognosis estimation.