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Impact of injections during diagnostic coronary arteriography on coronary patency in the setting of acute myocardial infarction from the TIMI trials

      Although the primary end point of many angiographic thrombolytic patency trials is assessed at 90 minutes, injections are often performed before this standard time point. The Thrombolysis In Myocardial Infarction (TIMI) Angiographic Core Laboratory uses the first injection at each time point (60, 75, and 90 minutes) after thrombolytic administration to assess the TIMI flow grade and the corrected TIMI frame count (CTFC). Whereas the coronary arteriogram is conventionally viewed as “diagnostic,” the frequency with which this first injection might be “therapeutic” and contribute to the mechanical opening of occluded coronary arteries is not well defined. We hypothesized that mechanical opening is infrequent, and we studied 4,021 consecutive first injections (815 that were occluded) in the TIMI 10B and 14 trials to define its frequency and to determine the potential impact that injections have on patency rates in thrombolytic trials.
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