Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: Results from the HORIZONS-AMI trial

Adriano Caixeta, Alexandra J. Lansky, Roxana Mehran, Sorin J. Brener, Bimmer Claessen, Philippe Geńéreux, Tullio Palmerini, Bernhard Witzenbichler, Giulio Guagliumi, Bruce R. Brodie, Dariusz Dudek, Martin Fahy, George D. Dangas, Gregg W. Stone

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31 Scopus citations


Aims: The predictors of TIMI flow <3 after PCI in patients with acute myocardial infarction have not been examined in a contemporary, large-scale multicentre prospective study. Methods and results: The HORIZONS-AMI trial randomised 3,602 patients with STEMI undergoing primary PCI to bivalirudin (n=1,800) vs. unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (n=1,802). A total of 3,845 treated lesions (3,362 vessels) were analysed by the core lab; 2,942 vessels (87.5%) and 2,758 patients (87.1%) had final TIMI 3 flow, while 407 (12.9%) had TIMI flow <3. The independent predictors of TIMI flow <3 were age (OR 1.23 per 10-year increase; 95% CI: 1.12 to 1.35; p<0.0001), anterior MI (OR 1.65; 95% CI: 1.33 to 2.05; p<0.0001), baseline TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; p<0.0001), and lesion length (OR 1.05 per 10 mm increase; 95% CI: 1.02 to 1.09; p=0.005). The three-year mortality of patients in whom final TIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; p<0.0001). Conclusions: In this large-scale, randomised trial, failure to restore normal TIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. Clinical Trial Registration: Unique identifier: NCT00433966.

Original languageEnglish
Pages (from-to)220-227
Number of pages8
Issue number2
StatePublished - 2013


  • Myocardial infarction
  • Stents
  • TIMI flow


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