Impaired culprit vessel flow in acute coronary syndromes ineligible for thrombolysis

The majority of patients with acute myocardial infarction and other acute c oronary syndromes (ACS) are considered ineligible for thrombolysis and do n ot routinely receive reperfusion therapy. We hypothesized that predictors a nd outcomes of angiographically impaired culprit vessel flow can be identif ied and compared. This trial evaluated the outcomes following triage angiog raphy in acute coronary syndromes ineligible for thrombolytic therapy. Elig ible patients (n = 201) with < 24 hours of symptoms were randomized to earl y triage angiography and subsequent therapies based on the angiogram versus conventional medical therapy. This analysis was performed in 165 patients, from experimental and control arms, in whom angiography was performed on t he index hospitalization with the outcome of interest being target vessel f low (Thrombolysis In Myocardial Infarction [TIMI] grades 0 to 2) on initial angiography. Patients with and without impaired culprit lesion flow were s imilar with respect to age, gender, diabetes, and prior coronary disease. A family history of premature coronary disease was more common in those with impaired flow, 50.0 versus 28.5% (p = 0.02). Abnormal culprit vessel flow was found in 19.2% of patients who underwent angiography within 6 hours of symptom onset; however, after 24 hours this rate was reduced to 11.7%. Impa ired culprit lesion flow can be expected in approximately 20% of patients p resenting with ACS who are ineligible for reperfusion therapy by convention al guidelines and therefore represents an opportunity for early interventio n within 6 hours of the onset of symptoms in these patients.