Relationship between TIMI frame count and clinical outcomes after thrombolytic administration

Background-The corrected TIMI frame count (CTFC) is the number of cine fram es 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, 1 0A, and 10B trials, and its relationship to clinical outcomes was examined. Patients who died in the hospital had a higher CTFC tie, slower flow) than survivors (69.6+/-35.4 [n=53] versus 49.5 +/- 32.3 [n= 1195]; P=0.0003). L ikewise, 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 multivaria te model that excluded TIMI flow grades, the 90-minute CTFC was an independ ent predictor of in-hospital mortality (OR=1.21 per 10-frame rise [95% CI, 1.1 to 1.3], an approximate to 0.7% increase in absolute mortality for ever y 10-frame rise; P<0.001) even when other significant correlates of mortali ty (age, heart rate, anterior myocardial infarction, and female sex) were a djusted for in the model. The CTFC identified a subgroup of patients with T IMI grade 3 flow who were at a particularly low risk of adverse outcomes. T he 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 fo r 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 pre viously been identified as the cutpoint for distinguishing TIMI,grade 3 flo w), to 6.4% (35/549) in patients with a CTFC >40 (P=0.003). Although the ri sk of death, recurrent myocardial infarction, shock, congestive heart failu re, or left ventricular ejection fraction less than or equal to 40% was 13. 0% among patients with TIMI grade 3 flow (CTFC less than or equal to 40), t he CTFC tended to segregate patients into lower-risk (CTFC less than or equ al to 20, risk of adverse outcome of 7.9%) and higher-risk subgroups (CTFC >20 to less than or equal to 40, risk of adverse outcome of 15.5%; P=0.17). Conclusions-Faster (lower) 90-minute CTFCs are related to improved in-hospi tal and 1-month clinical outcomes after thrombolytic administration in both univariate and multivariate models. Even among those patients classified a s having normal flow (TIMI grade 3 flow, CTFC less than or equal to 40), th ere may be lower- and higher-risk subgroups.