Implications of the TIMI Trials

  • Allan M. Ross
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 281)


The TIMI Trials consist of three primary studies plus numerous ancillary observations. TIMI I was the direct reperfusion comparison between streptokinase and TPA. The central observations were: Higher reperfusion rates with TPA; Equivalent frequencies of bleeding complications; No differences in clinical outcome parameters; Only early reperfusion produced LV function improvement. TIMI IIA compared routine post-IV lytic therapy (TPA) immediate PTCA with a delayed interventional approach at 18-48 hours post lysis. The study demonstrated: Equivalent outcome LV function; Equivalent mortality rates; More emergency CABG in the “immediate” group; More hemorrhagic complications in the immediate group. TIMI IIB compared delayed but routine interventional post-lytic care (PTCA) with a more conservative strategy. Additionally patients were secondarily randomized to acute administration of IV beta blocker (metoprolol) or delayed administration of beta blocker, starting on Day 6. The primay results of this investigation include: A very low early (2 week) mortality rate with either strategy (about 5%); preserved low mortality at the one year follow up for both groups; no dif­ference (routine intervention versus conservative strategy) in outcome LV function; no difference in comparative mortality rates; less recurrent ischemia in the routine PTCA group; 13% need for PTCA in the conservative group; no difference in LV function based upon beta blockade assignment but some decrease in mortality in acute beta blockade subgroups.


Beta Blockade Recurrent Ischemia Infarct Artery Intra Cerebral Hemorrhage Lytic Therapy 
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  1. 1.
    J. H. Chesebro, G. Knatterud, R. Roberts, J. Borer, L. S. Cohen, J. Dalen, H. T. Dodge, C. K. Francis, D. Hillis, P. Ludbrook, J. E. Markis, H. Mueller, E. R. Passamani, E. R. Powers, A. K. Rao, T. Robertson, A. Ross, T. J. Ryan, B. E. Sobel, J. Willerson, D. O. Williams, B. L. Zaret, and E. Braunwald: Thrombolysis in myocardial infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptoknase. Circulation, 76:142–154 (1987).PubMedCrossRefGoogle Scholar
  2. 2.
    F. H. Sheehan, E. Braunwald, P. Canner, H. T. Dodge, J. Gore, P. Van Natta, E. R. Passamani, D. O. Willams, B. Zaret, and Co-Investigators: The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissuetype plasminogen activator and streptokinase from the thrombolysis in myocardial infarction (TIMI Phase I) trial. Circulaton, 75:817–829 (1987).CrossRefGoogle Scholar
  3. 3.
    F. J. Wackers, M. L. Terrin, D. S. Kayden, G. Knatterud, S. Forman, E. Braunwald, B. L. Zaret, and the TIMI Investigators: Quantitative radionuclide assessment of regional ventricular function after thrombolysis therapy for acute myocardial in­farction: results of phase I thrombolysis in myocardial infarction (TIMI) trial. JACC, 13:998–1005 (1989).PubMedGoogle Scholar
  4. 4.
    J. E. Dalen, J. M. Gore, E. Braunwald, J. Borer, R. J. Goldberg, E. R. Passamani, S. Forman, G. Knatterud, and the TIMI Investigators: Six-and twelve-month follow-up of the phase I thrombolysis in myocardial infarction (TIMI) trial. AJC, 62:179–185 (1988).CrossRefGoogle Scholar
  5. 5.
    H. S. Mueller, A. K. Rao, S. A. Forman, and the TIMI Investigators: Thrombolysis in myocardial infarction (TIMI): comparative studies of coronary reperfusion and systemic fibrinogenolysis with two forms of recombinant tissue-type plasminogen activator. JACC, 10:479–490 (1987).PubMedGoogle Scholar
  6. 6.
    The TIMI Research Group: Immediate vs delayed catheterization and angioplasty following thrombolytic therapy for acute myocardial infarction. JAMA, 260:2849–2858 (1988).CrossRefGoogle Scholar
  7. 7.
    The TIMI Study Group: Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. N. Eng. J. Med., 320:618–627 (1989).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Allan M. Ross
    • 1
  1. 1.George Washington UniversityUSA

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