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(Circulation. 2001;104:624.)
© 2001 American Heart Association, Inc.

Editorial

Importance of TIMI 3 Flow

Christopher P. Cannon, MD

From the Cardiovascular Division and TIMI Study Group, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Christopher P. Cannon, MD, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail cpcannon@partners.org www.timi.org

Key Words: Editorials • angioplasty • catheterization • myocardial infarction • platelet aggregation inhibitors • stents • thrombolysis

Since the advent of reperfusion therapy for acute ST elevation myocardial infarction, the "open artery hypothesis" proposed that benefit is achieved from early reperfusion of the occluded coronary artery, which limits the size of infarction, reduces the degree of left ventricular dysfunction, and improves survival.¹ After numerous studies confirmed the benefit of a patent infarct-related artery, more careful examination of the degree of reperfusion was performed using the Thrombolysis in Myocardial Infarction (TIMI) flow grading system devised in the TIMI 1 trial.² When differentiating apparently normal TIMI grade 3 flow from more delayed TIMI grade 2 flow in patent arteries, greater myocardial salvage and improved survival were observed in patients who achieved TIMI grade 3 flow.^3,4 There is a nearly linear correlation between higher rates of early TIMI grade 3 flow and improved survival, regardless of whether reperfusion is achieved with thrombolysis or primary percutaneous coronary intervention (PCI).⁴

See p 636

The open artery hypothesis became the "open artery theory"⁵ after the results of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) I trial.^6,7 This trial demonstrated that a more aggressive thrombolytic regimen (using tissue plasminogen activator [t-PA]) that could improve the achievement of early TIMI grade 3 flow could also reduce mortality.^6,7 Thus, an active treatment that increased TIMI grade 3 flow led to improved survival.

The importance of time to achieving reperfusion has also been emphasized by several types of studies, including observational studies of time to treatment versus mortality.^4,8 Trials of . . . [Full Text of this Article]

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