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Coronary artery patency and outcome after myocardial infarction

Richard C Becker, MD
Carey Kimmelstiel, MD
Section Editor
Freek Verheugt, MD, FACC, FESC
Deputy Editor
Gordon M Saperia, MD, FACC


It is widely accepted that the likelihood of death after myocardial infarction (MI) correlates inversely with left ventricular performance. In turn, the degree of left ventricular dysfunction is determined by the extent of myocardial necrosis or infarct size. Thus, pump failure and increased mortality result when the infarct is large and ventricular compromise is severe [1,2].

Prompt and sustained coronary arterial patency has repeatedly been found to limit infarct size. Among patients with an acute ST-elevation MI (STEMI), over 90 percent have complete occlusion of the culprit artery. Patency can be achieved by primary percutaneous coronary intervention (PCI), fibrinolysis or a combination of both modalities. In addition, there are many factors (hemodynamic, anatomic, cellular) that influence coronary artery patency regardless of the technique used (figure 1). (See "Characteristics of fibrinolytic (thrombolytic) agents and clinical trials in acute ST elevation myocardial infarction" and "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome" and "Primary percutaneous coronary intervention versus fibrinolysis in acute ST elevation myocardial infarction: Clinical trials".)


The degree of perfusion in the infarct-related artery (IRA) is typically described by the TIMI flow grade:

TIMI 0 refers to the absence of antegrade flow beyond a coronary occlusion.

TIMI 1 flow is faint antegrade coronary flow beyond the occlusion, although filling of the distal coronary bed is incomplete.

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Literature review current through: Nov 2017. | This topic last updated: Sep 08, 2017.
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