![]() Another limitation of the TIMI flow grade is that it provides ordinal values rather than continuous ones, limiting its statistical power in clinical trials. The lack of concordance for determining TIMI flow grade was also shown between experienced angiographic core laboratories. Substantial observer variability has been noted with the TIMI flow grade, with the best agreement between the angiographic core laboratory and clinical centers occurring when the artery is graded as either open or closed (TIMI 0 or 1 flow kappa value = 0.84).81 Observer agreement is only moderate when assessing TIMI grade 3 flow (kappa value = 0.55) and is poor in the assessment of TIMI grade 2 flow (kappa value = 0.38). In contrast, the mortality rate was lowest (4.4%) in patients with TIMI 3 flow.83ĭespite these important associations, there are a number of limitations of the TIMI classification system. Thrombolysis and clinical outcome.83 In the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) angiographic substudy, the mortality rate for patients with TIMI 2 flow (7.4%) was similar to the mortality rate for those with TIMI 0 or 1 flow (8.9%). Modified from Sheehan FH, Braunwald E, Canner P, et al: The effect of intravenous thrombolytic therapy on left ventricular function: A report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI) Phase I Trial. Alternatively, contrast material clears from a segment distal to a stenosis noticeably more slowly than from a comparable segment not preceded by a significant stenosis.Ī small amount of contrast flows through the stenosis but fails to fully opacify the artery beyond. However, contrast enters the terminal segment perceptibly more slowly than more proximal segments. Contrast material clears as rapidly from the distal segment as from an uninvolved, more proximal segment.Ĭontrast material flows through the stenosis to opacify the terminal artery segment. TIMI Flow Grade Classificationģ (complete reperfusion) 2 (partial reperfusion)ġ (penetration with minimal perfusion) 0 (no perfusion)Īnterograde flow into the terminal coronary artery segment through a stenosis is as prompt as anterograde flow into a comparable segment proximal to the stenosis. Several throm-bolytic trials have identified an important relationship between 90-minute TIMI flow grade after In addition, we have used our large database of clinical findings, biomarkers, and genotypes to enhance the understanding of cardiovascular disease and its risk factors.īy leading large-scale, international, randomized controlled trials of novel therapeutics and performing sophisticated analyses, we have been privileged to help shape the very practice of cardiovascular medicine for over a quarter of a century.The TIMI Flow Grade System is a valuable tool for assessing the efficacy of reperfusion strategies in patients with STEMI and for identifying patients at higher risk for an adverse outcome with acute coronary syndromes or undergoing PCI. We investigate a broad array of therapeutic interventions in individuals across the spectrum of cardiovascular disease, ranging from prevention in those with risk factors, to emergent interventions in those with acute manifestations of disease. Trials have been conducted in over 50 countries and at more than 5000 separate sites. We have led a wide array of trials, from phase I to phase IV, enrolling from less than 30 to more than 26,000 subjects, and with both industry and NIH support. Since its inception in 1984, the TIMI Study Group has been an Academic Research Organization dedicated to advancing the knowledge and care of patients suffering from cardiovascular disease and its risk factors.
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