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Abstract

Background: Optimal coronary reperfusion through PPCI in ST-elevation myocardial infarction (STEMI) is essential for improving outcomes. The Thrombolysis in Myocardial Infarction (TIMI) flow grade remains the definitive standard for evaluating epicardial perfusion success. Objectives: To investigate TIMI (0-3) flow grades in a cohort of 500 STEMI patients undergoing PPCI with door-to-balloon (D2B) times of ≥90 min and identify clinical, angiographic, and procedural determinants of achieving optimal TIMI (3) flow. Methods: This retrospective cohort study examined 500 patients with STEMI and D2B times ≥90 min who underwent PPCI over 12 months. Data on clinical, angiographic, and procedural characteristics were collected, and multivariate regression analysis was used to determine the predictors of TIMI (3) flow grade. Results: In a cohort of 500 patients (mean age 64.8 ± 11.5 years, 70.4% males), TIMI (3) flow was achieved in 357 patients (71.4%). The TIMI grade distribution was as follows: TIMI (0) in 52 patients (10.4%), TIMI (1) in 43 patients (8.6%), and TIMI (2) in 48 patients (9.6%). A significant inverse correlation existed between in-hospital mortality and TIMI flow grade, with mortality rates of 30.8% for TIMI (0), 20.9% for TIMI (1), 12.5% for TIMI (2), and 4.5% for TIMI (3) (p<0.001). Independent predictors of suboptimal TIMI flow included advanced age (OR 1.04, 95% CI 1.02-1.07), extended D2B time (OR 1.02, 95% CI 1.00-1.04), diabetes mellitus (OR 1.58, 95% CI 1.08-2.31), and Killip Class II-IV (OR 1.72, 95% CI 1.15-2.58). Conclusions: In a cohort of 500 STEMI patients with D2B times ≥90 min, 71.4% achieved an optimal TIMI grade (3). TIMI grade denotes a key indicator of in-hospital mortality. These findings highlight the need to optimise procedures and implement targeted interventions in high-risk subgroups.