Do improved epicardial flow and tissue-level perfusion at 90 minutes after thrombolytic administration improve 2-year survival in patients with acute myocardial infarction?
Improved epicardial flow and microvascular perfusion after thrombolysis in acute myocardial infarction are independently associated with better long-term survival, highlighting the importance of both macro- and microvascular reperfusion.
Both improved epicardial flow (TFG 2/3 and low CTFCs) and tissue-level perfusion (TMPG 2/3) at 90 minutes after thrombolytic administration are independently associated with improved 2-year survival, suggesting complementary mechanisms of improved long-term survival. Although rescue PCI reduced long-term mortality, improved microvascular perfusion (TMPG 2/3) before PCI was also related to improved mortality independently of epicardial blood flow and the performance of rescue or adjunctive PCI. Further prospective trials are warranted to re-examine the benefit of early PCI with thrombolysis.
Gibson et al. (Tue,) studied this question.