(Circulation. 1999;99:1945-1950.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Relationship Between TIMI Frame Count and Clinical Outcomes After Thrombolytic Administration
From the Cardiovascular Division of the Department of Medicine, the Allegheny General Hospital, Pittsburgh, Pa (C.M.G., S.A.M., M.J.R., K.A.R., S.J.M.); Leuven University, Leuven, Belgium (F.V.d.W.); and Brigham & Women's Hospital, Boston, Mass (C.H.M., C.P.C., E.B.).
Background—The corrected TIMI frame count (CTFC) is the number of cine frames required for dye to first reach standardized distal coronary landmarks, and it is an objective and quantitative index of coronary blood flow.
Methods and Results—The CTFC was measured in 1248 patients in the
TIMI 4, 10A, and 10B trials, and its relationship to clinical outcomes
was examined. Patients who died in the hospital had a higher CTFC (ie,
slower flow) than survivors (69.6±35.4 [n=53] versus 49.5±32.3
[n=1195]; P=0.0003). Likewise, patients who died by 30
to 42 days had higher CTFCs than survivors (66.2±36.4 [n=57] versus
49.9±32.1 [n=1059]; P=0.006). In a
multivariate model that excluded TIMI flow grades, the
90-minute CTFC was an independent predictor of in-hospital mortality
(OR=1.21 per 10-frame rise [95% CI, 1.1 to 1.3], an 
0.7%
increase in absolute mortality for every 10-frame rise;
P<0.001) even when other significant correlates of
mortality (age, heart rate, anterior myocardial infarction, and female
sex) were adjusted for in the model. The CTFC identified a subgroup of
patients with TIMI grade 3 flow who were at a particularly low risk of
adverse outcomes. The risk of in-hospital mortality increased in a
stepwise fashion from 0.0% (n=41) in patients with a 90-minute CTFC
that was faster than the 95% CI for normal flow (0 to 13 frames,
hyperemia, TIMI grade 4 flow), to 2.7% (n=18 of 658 patients)
in patients with a CTFC of 14 to 40 (a CTFC of 40 has previously been
identified as the cutpoint for distinguishing TIMI grade 3 flow), to
6.4% (35/549) in patients with a CTFC >40 (P=0.003).
Although the risk of death, recurrent myocardial infarction, shock,
congestive heart failure, or left ventricular
ejection fraction 
40% was 13.0% among patients with TIMI grade 3
flow (CTFC 40), the CTFC tended to segregate patients into lower-risk
(CTFC 20, risk of adverse outcome of 7.9%) and higher-risk
subgroups (CTFC >20 to 40, risk of adverse outcome of 15.5%;
P=0.17).
Conclusions—Faster (lower) 90-minute CTFCs are related to
improved in-hospital and 1-month clinical outcomes after
thrombolytic administration in both
univariate and multivariate models. Even
among those patients classified as having normal flow (TIMI grade 3
flow, CTFC 40), there may be lower- and higher-risk subgroups.
Key Words: thrombolysis • myocardial infarction • blood flow • TIMI frame count
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