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(Circulation. 1996;93:879-888.)
© 1996 American Heart Association, Inc.
Articles |
TIMI Frame Count
A Quantitative Method of Assessing Coronary Artery Flow
From the Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital and West Roxbury Veteran's Administration Hospital, Harvard Medical School, Boston, Mass (C.M.G., C.P.C., W.L.D., J.T.D., S.J.M., C.H.M., L.R., T.F., E.B.), and Research Triangle Institute, Research Triangle Park, NC (B.A., W.K.P.). A complete listing of all participants in the TIMI 4 trial can be found in the appendix of Reference 8.
Background Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is a valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature.
Methods and Results In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7±3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2±2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4±3.0) and circumflex counts (22.2±4.1, P<.001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2±20.0 frames, which improved to 31.7±12.9 frames by 18 to 36 hours (P<.001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5±9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0±3.1, P<.001) but improved to that of normal arteries by 1 day after thrombolysis (21.7±7.1, P=NS).
Conclusions The CTFC is a simple, reproducible, objective, and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
Key Words: angiography • thrombolysis • myocardial infarction • blood flow • microcirculation
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F. Burzotta, C. Trani, E. Romagnoli, M. A. Mazzari, A. G. Rebuzzi, M. De Vita, B. Garramone, F. Giannico, G. Niccoli, G. G.L. Biondi-Zoccai, et al. Manual Thrombus-Aspiration Improves Myocardial Reperfusion: The Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus-Aspiration in Primary and Rescue Angioplasty (REMEDIA) Trial J. Am. Coll. Cardiol., July 19, 2005; 46(2): 371 - 376. [Abstract] [Full Text] [PDF]
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A. T. Sezgin, E. Topal, I. Barutcu, R. Ozdemir, H. Gullu, E. Bariskaner, N. Ermis, I. Tandogan, N. Acikgoz, and N. Sivri Impaired Left Ventricle Filling in Slow Coronary Flow Phenomenon: An Echo-Doppler Study Angiology, July 1, 2005; 56(4): 397 - 401. [Abstract] [PDF]
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 R. Sciagra, G. Parodi, A. Pupi, A. Migliorini, R. Valenti, G. Moschi, G. M. Santoro, G. Memisha, and D. Antoniucci Gated SPECT Evaluation of Outcome After Abciximab-Supported Primary Infarct Artery Stenting for Acute Myocardial Infarction: The Scintigraphic Data of the Abciximab and Carbostent Evaluation (ACE) Randomized Trial J. Nucl. Med., May 1, 2005; 46(5): 722 - 727. [Abstract] [Full Text] [PDF]
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M. J. Claeys, M. G. Van der Planken, J. M. Bosmans, J. J. Michiels, F. Vertessen, P. Van Der Goten, F. L. Wuyts, and C. J. Vrints Does pre-treatment with aspirin and loading dose clopidogrel obviate the need for glycoprotein IIb/IIIa antagonists during elective coronary stenting? A focus on peri-procedural myonecrosis Eur. Heart J., March 2, 2005; 26(6): 567 - 575. [Abstract] [Full Text] [PDF]
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K. K. Ray, D. A. Morrow, C. M. Gibson, S. Murphy, E. M. Antman, E. Braunwald, and for the ENTIRE-TIMI 23 Study Group Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome: An ENTIRE-TIMI 23 substudy Eur. Heart J., March 1, 2005; 26(5): 440 - 446. [Abstract] [Full Text] [PDF]
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I. Klem, W. G. Rehwald, J. F. Heitner, A. Wagner, T. Albert, M. A. Parker, E.-L. Chen, R. J. Kim, and R. M. Judd Noninvasive Assessment of Blood Flow Based on Magnetic Resonance Global Coherent Free Precession Circulation, March 1, 2005; 111(8): 1033 - 1039. [Abstract] [Full Text] [PDF]
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A. Pfosser, M. Thalgott, K. Buttner, A. Brouet, O. Feron, P. Boekstegers, and C. Kupatt Liposomal Hsp90 cDNA induces neovascularization via nitric oxide in chronic ischemia Cardiovasc Res, February 15, 2005; 65(3): 728 - 736. [Abstract] [Full Text] [PDF]
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Y Ohara, Y Hiasa, T Takahashi, K Yamaguchi, R Ogura, T Ogata, K Yuba, K Kusunoki, S Hosokawa, K Kishi, et al. Relation between the TIMI frame count and the degree of microvascular injury after primary coronary angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2005; 91(1): 64 - 67. [Abstract] [Full Text] [PDF]
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 K. A. Bybee, T. Kara, A. Prasad, A. Lerman, G. W. Barsness, R. S. Wright, and C. S. Rihal Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction Ann Intern Med, December 7, 2004; 141(11): 858 - 865. [Abstract] [Full Text] [PDF]
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M. Gyongyosi, H. Domanovits, W. Benzer, M. Haugk, B. Heinisch, G. Sodeck, R. Hodl, G. Gaul, G. Bonner, J. Wojta, et al. Use of abciximab prior to primary angioplasty in STEMI results in early recanalization of the infarct-related artery and improved myocardial tissue reperfusion - results of the Austrian multi-centre randomized ReoPro-BRIDGING Study Eur. Heart J., December 1, 2004; 25(23): 2125 - 2133. [Abstract] [Full Text] [PDF]
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J.-i. Kotani, G. S. Mintz, P. B. Rai, C. K. Pappas, N. Gevorkian, A. B. Bui, A. D. Pichard, L. F. Satler, W. O. Suddath, R. Waksman, et al. Intravascular ultrasound assessment of angiographic filling defects in native coronary arteries: Do they always contain thrombi? J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2087 - 2089. [Full Text] [PDF]
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C. M. Gibson, R. L. Dumaine, E. V. Gelfand, S. A. Murphy, D. A. Morrow, S. D. Wiviott, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al. Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials Eur. Heart J., November 2, 2004; 25(22): 1998 - 2005. [Abstract] [Full Text] [PDF]
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L. Bolognese, K. Ducci, P. Angioli, G. Falsini, F. Liistro, S. Baldassarre, and A. Burali Elevations in Troponin I After Percutaneous Coronary Interventions Are Associated With Abnormal Tissue-Level Perfusion in High-Risk Patients With Non-ST-Segment-Elevation Acute Coronary Syndromes Circulation, September 21, 2004; 110(12): 1592 - 1597. [Abstract] [Full Text] [PDF]
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N. M.S.K.J. Ernst, H. Suryapranata, K. Miedema, R. J. Slingerland, J. P. Ottervanger, J. C.A. Hoorntje, A.T.M. Gosselink, J.-H. E. Dambrink, M.-J. de Boer, F. Zijlstra, et al. Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1187 - 1193. [Abstract] [Full Text] [PDF]
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C. M. Gibson, S. A. Murphy, A. J. Kirtane, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, and TIMI Study Group Association of duration of symptoms at presentation with angiographic and clinical outcomes after fibrinolytic therapy in patients with st-segment elevation myocardial infarction J. Am. Coll. Cardiol., September 1, 2004; 44(5): 980 - 987. [Abstract] [Full Text] [PDF]
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K. Iwakura, H. Ito, S. Kawano, A. Okamura, K. Tanaka, Y. Nishida, Y. Maekawa, and K. Fujii Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices Eur. Heart J., September 1, 2004; 25(17): 1526 - 1533. [Abstract] [Full Text] [PDF]
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S. K. Chugh, J. Koppel, M. Scott, L. Shewchuk, D. Goodhart, R. Bonan, J.-C. Tardif, S. G. Worthley, C. DiMario, M. J. Curtis, et al. Coronary flow velocity reserve does not correlate with TIMI frame count in patients undergoing non-emergency percutaneous coronary intervention J. Am. Coll. Cardiol., August 18, 2004; 44(4): 778 - 782. [Abstract] [Full Text] [PDF]
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C. M. Gibson, L. K. Jennings, S. A. Murphy, D. P. Lorenz, R. P. Giugliano, R. A. Harrington, S. Cholera, R. Krishnan, R. M. Califf, E. Braunwald, et al. Association Between Platelet Receptor Occupancy After Eptifibatide (Integrilin) Therapy and Patency, Myocardial Perfusion, and ST-Segment Resolution Among Patients With ST-Segment-Elevation Myocardial Infarction: An INTEGRITI (Integrilin and Tenecteplase in Acute Myocardial Infarction) Substudy Circulation, August 10, 2004; 110(6): 679 - 684. [Abstract] [Full Text] [PDF]
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S. Sadanandan, C. P. Cannon, K. Chekuri, S. A. Murphy, P. M. DiBattiste, D. A. Morrow, J. A. de Lemos, E. Braunwald, and C. M. Gibson Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., August 4, 2004; 44(3): 564 - 568. [Abstract] [Full Text] [PDF]
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H. Sato, H. Iida, A. Tanaka, H. Tanaka, S. Shimodouzono, E. Uchida, T. Kawarabayashi, and J. Yoshikawa The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: A major role of percutaneous coronary intervention-induced embolization J. Am. Coll. Cardiol., July 21, 2004; 44(2): 300 - 304. [Abstract] [Full Text] [PDF]
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J. F. Beltrame, S. P. Turner, S. L. Leslie, P. Solomon, S. B. Freedman, and J. D. Horowitz The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon J. Am. Coll. Cardiol., July 7, 2004; 44(1): 57 - 62. [Abstract] [Full Text] [PDF]
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C. M. Gibson and A. Schomig Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion Circulation, June 29, 2004; 109(25): 3096 - 3105. [Full Text] [PDF]
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A. W.J van't Hof, N. Ernst, M.-J. de Boer, R. de Winter, E. Boersma, T. Bunt, S. Petronio, A.T Marcel Gosselink, W. Jap, F. Hollak, et al. Facilitation of primary coronary angioplasty by early start of a glycoprotein 2b/3a inhibitor: results of the ongoing tirofiban in myocardial infarction evaluation (On-TIME) trial Eur. Heart J., May 2, 2004; 25(10): 837 - 846. [Abstract] [Full Text] [PDF]
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K. Greaves, S. R Dixon, I. O. Coker, A. I Mallet, M. Vkiran, M. J Shattock, M. J Fejka, W. W O'Neill, R. Senior, S. Redwood, et al. Influence of isoprostane F2{alpha}-III on reflow after myocardial infarction Eur. Heart J., May 2, 2004; 25(10): 847 - 853. [Abstract] [Full Text] [PDF]
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C. M. Gibson, J. Karha, S. A. Murphy, J. A. de Lemos, D. A. Morrow, R. P. Giugliano, M. T. Roe, R. A. Harrington, C. P. Cannon, E. M. Antman, et al. Association of a pulsatile blood flow pattern on coronary arteriography and short-term clinical outcomes in acute myocardial infarction J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1170 - 1176. [Abstract] [Full Text] [PDF]
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M. T Dirksen, G. Laarman, A. W.J van 't Hof, G. Guagliumi, W. A.L Tonino, L. Tavazzi, D. J.G.M Duncker, M. L Simoons, and on behalf of the PARI-MI Investigators The effect of ITF-1697 on reperfusion in patients undergoing primary angioplasty: Safety and efficacy of a novel tetrapeptide, ITF-1697 Eur. Heart J., March 1, 2004; 25(5): 392 - 400. [Abstract] [Full Text] [PDF]
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M. Bax, R. J. de Winter, C. E. Schotborgh, K. T. Koch, M. Meuwissen, M. Voskuil, R. Adams, K. J. J. Mulder, J. G. P. Tijssen, and J. J. Piek Short- and Long-Term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 534 - 541. [Abstract] [Full Text] [PDF]
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D. Antoniucci, A. Rodriguez, A. Hempel, R. Valenti, A. Migliorini, F. Vigo, G. Parodi, C. Fernandez-Pereira, G. Moschi, A. Bartorelli, et al. A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1879 - 1885. [Abstract] [Full Text] [PDF]
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S. Lee, Y. Otsuji, S. Minagoe, S. Hamasaki, K. Toyonaga, M. Negishi, M. Tsurugida, H. Toda, and C. Tei Noninvasive Evaluation of Coronary Reperfusion by Transthoracic Doppler Echocardiography in Patients With Anterior Acute Myocardial Infarction Before Coronary Intervention Circulation, December 2, 2003; 108(22): 2763 - 2768. [Abstract] [Full Text] [PDF]
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F. Burzotta, E. Romagnoli, C. Trani, F. Crea, J. Wohrle, O. C. Grebe, T. Nusser, E. Al-Khayer, S. Schaible, M. Kochs, et al. Intracoronary Administration of Abciximab Acutely Increases Flow Through Culprit Vessels of Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention * Response Circulation, November 11, 2003; 108 (19): e138 - e138. [Full Text] [PDF]
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C. M. Gibson, D. S. Pinto, S. A. Murphy, D. A. Morrow, H.-P. Hobbach, S. D. Wiviott, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al. Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1535 - 1543. [Abstract] [Full Text] [PDF]
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