How do you evaluate the success of thrombolysis or primary PCI ?
If you say its coronary angiogram and the final snapshot of TIMI flow , you need to read further. If you thought its actually the quantum of ECG ST regression . . . great , you can exit this page with credits.
CAG may not be the gold standard in defining PCI success , it just tells you whether IRA is patent or not .Instead , the good old ECG tells you about whether the myocardium is successfully reperfused or not . TIMI flows are simply not good enough to identify adequacy of myocardial reperfusion .
By the way , who is telling this ?
That’s what the simple message I got from this landmark study published in year the 2000 in JACC by Shah.A in the thrombolytic era.The Importance of this paper has far reaching consequences (If and only if we are willing to accept and understand the concept and apply as a whole in PCI era )
While success of thrombolysis is faith fully subjected to the acid tests of myocardial perfusion , primary PCI is rarely ever assessed in terms of ST segment regression.
What is the next logical step this study should lead us to ?
I think I am not provocating , . . How to get rid of the prevailing practice of jacking up the success rate of primary PCI ? ( Conveniently, Ignoring the echo detected significant LV dysfunction on follow up ) Mind you, this has resulted in creating a new crop of patient sub group called “Angiographic success and myocardial failure”
Dear colleagues , please go thorough this article . Its from the thought leaders , Duke University ,North Carolina. I would argue the cardiology fellows to discuss this paper in detail in their journal club as “classic paper” till they completely understand the conclusion .Though its done with GUSTO 1 data in primarily lytic population, its conclusions are very much valid as an assessment tool in reperfusion by any means.I am afraid, even 16 years after this paper got published ,the truth has not penetrated to the targeted population within the cardiology community.
Prognostic implications of TIMI flow grade in the infarct related artery compared with continuous 12-lead ST-segment resolution analysis. Reexamining the “gold standard” for myocardial reperfusion assessment. Shah A1, Wagner GS, Granger CB, J Am Coll Cardiol. 2000 Mar 1;35(3):666-72.