Non-achievement of TIMI-3-flow results in significant increase in hospital mortality of primary PCI for STEMI and PCI for NSTE-ACS - findings of the Euro Heart survey PCI-registry

Background: Acute reperfusion is common in ACS within Europe. High success rates of reperfusion have resulted in improvement of hospital outcome. Little is known about the impact of failed PCI of STEMI and NSTE-ACS in clinical practice in Europe. Methods: Between 2005 and 2008, 47,407 consecutive patients undergoing PCI were enrolled into the PCI-Registry of the Euro Heart Survey Programme to document patient characteristics, PCI details and hospital complications in different PCI indications. We examined the impact of TIMI-3 flow after PCI of the culprit lesion in patients with STEMI and NSTE-ACS in clinical practice. Results: TIMI 3 flow was reached in 90.5% of patients undergoing primary PCI for STEMI and in 95.3% of patients undergoing PCI for NSTE-ACS. STEMI patients with TIMI-3 flow were younger, less often had prior MI or prior CABG. No relevant differences were found in the localization of the culprit stenosis, but less patients with TIMI-3 after PCI had TIMI-0 before PCI. Hospital mortality was higher in patients in whom no TIMI 3 flow was achieved for both STEMI and NSTE-ACS. Conclusion: TIMI-3 flow was not achieved in 9.5% of patients undergoing primary PCI for STEMI and in 4.7% of patients undergoing PCI for NSTE-ACS. Non-achievement of TIMI-3 was associated with significantly higher hospital mortality for both STEMI as well as NSTE-ACS in clinical practice.