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(Circulation. 2000;102:e19.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Is the Corrected TIMI Frame Count an Independent Predictor of Adverse Outcome?

Deepak L. Bhatt, MD

Department of Cardiology

Stephen G. Ellis, MD

Director, Sones Cardiac Catheterization Laboratory Cleveland Clinic Foundation, Cleveland, Ohio

	Introduction

 
To the Editor:

The corrected TIMI frame count (cTFC) has evolved into a standard measurement in many angiographic core laboratories. Although the reproducibility of the cTFC has been demonstrated,^{1 2} its superiority to TIMI flow grading has remained in question. Work done in our core laboratory has not found the cTFC to have predictive value independent of TIMI flow grading.³ The recent analysis by Gibson et al⁴ is the first to show that the cTFC correlates with adverse clinical outcomes. However, we are concerned that the analysis examined both cTFC and TIMI flow in separate multivariate models. This approach circumvents the real question of whether the cTFC adds any prognostic information over and above standard TIMI flow grading in a core laboratory setting. If not, the added time and substantial effort needed to measure cTFC cannot legitimately be justified.

	References

 
1. Ivanc TB, Crowe TD, Balazs EM, et al. Reproducibility of the corrected TIMI frame count in angiograms of MI patients receiving thrombolysis. J Am Coll Cardiol. 1998;31:11A. Abstract.

2. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–888.[Abstract/Free Full Text]

3. Bhatt DL, Ellis SG, Ivanc TB, et al. Corrected TIMI frame count does not predict 30 day adverse outcomes after reperfusion therapy for acute myocardial infarction. Am Heart J. 1999;138:785–790.[Medline] [Order article via Infotrieve]

4. Gibson CM, Murphy SA, Rizzo MJ, et al. Relationship between TIMI frame count and clinical outcomes after thrombolytic administration: Thrombolysis In Myocardial Infarction (TIMI) study group. Circulation. 1999;99:1945–1950.[Abstract/Free Full Text]

Response

C. Michael Gibson, MS, MD

Department of Medicine University of California–San Francisco, 3333 California Street, Suite 430, San Francisco, CA 94118

Sabina A. Murphy, MPH; Michael J. Rizzo, BS; Kathryn A. Ryan, BS; Susan J. Marble, RN, MS; Carolyn H. McCabe, BS; Christopher P. Cannon, MD; Frans Van de Werf, MD; Eugene Braunwald, MD

	Introduction

 
We appreciate the comments of Bhatt and Ellis. In a previous study, they demonstrated the precision and reproducibility of the corrected TIMI frame count (CTFC) (r=0.97 between observers).^R1 Manginas et al^R2 also recently demonstrated the accuracy of the CTFC method; they showed a highly significant correlation with Doppler velocity wire flow reserve measurements (r=0.88). The CTFC had a more significant P value than TIMI flow grades in a multivariable model of outcomes in our recent article,^R3 and it also tended to segregate patients with TIMI grade 3 flow into lower and higher risk subgroups, ie, it provided independent prognostic information, as would be seen in a multivariate model.^R3 . . . [Full Text of this Article]