Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous
Sorin J Brener1, Jose M Dizon, Roxana Mehran
1New York Methodist Hospital, Brooklyn, NY; Cardiovascular Research Foundation, New York, NY.
Insights
Myocardial blush grade (MBG) predicts long-term survival after percutaneous coronary intervention for ST-elevation myocardial infarction, while ST-segment resolution (STR) predicts freedom from revascularization. These measures are often discordant.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- ST-segment resolution (STR) and myocardial blush grade (MBG) are prognostic indicators following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- Assessing the concordance and independent prognostic value of MBG and STR is crucial for understanding reperfusion success and long-term patient outcomes.
Purpose of the Study:
- To determine the frequency of discordant measures between MBG and STR after primary PCI.
- To evaluate the independent prognostic significance of MBG and STR on long-term outcomes, including mortality and need for revascularization.
Main Methods:
- Analysis of core laboratory data from 2,367 patients in the HORIZONS-AMI trial who underwent primary PCI.
- Patients were categorized based on MBG (grades 2/3 vs. 0/1) and STR (≥50% vs. <50%).
- A multivariable model was used to identify predictors of 3-year mortality and major adverse cardiac events.
Main Results:
- MBG 2/3 was achieved in 77.7% and STR ≥50% in 75.1% of patients; discordance was observed in 30.9% of cases.
- MBG 2/3 independently predicted lower 3-year mortality (4.4% vs. 8.4%), whereas STR ≥50% did not.
- STR ≥50% predicted less frequent repeated revascularization (12.4% vs. 17.6%), while MBG 2/3 did not.
Conclusions:
- MBG and STR provide complementary prognostic information after primary PCI, with only about 70% concordance.
- MBG is a significant predictor of long-term survival.
- STR is a predictor of freedom from repeat revascularization.
Background:
Both ST-segment resolution (STR) and myocardial blush grade (MBG) have prognostic utility after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. We sought to clarify how frequently MBG and STR provide discordant measures of reperfusion success and to determine the independent prognostic significance of each on long-term outcomes.
Methods:
In HORIZONS-AMI, core laboratory measures of both MBG and STR were assessed in 2,367 patients undergoing primary PCI. Four groups were identified based on MBG (grades 2/3 vs 0/1) and STR (≥50% vs <50%). A multivariable model identified predictors of death and major adverse cardiac events at 3 years.
Results:
Myocardial blush grade 2/3 was achieved in 77.7% of patients, and STR ≥50% was achieved in 75.1% of patients. Myocardial blush grade and STR were discordant in 765 patients (30.9%). By multivariable analysis, MBG 2/3 compared with 0/1 was an independent predictor of lower mortality at 3 years (4.4% vs 8.4%, adjusted hazard ratio [HR] = 0.57 [0.39, 0.82], P = .003). In contrast, STR ≥50% compared with <50% was not associated with mortality (5.1% vs 5.9%, adjusted HR = 1.11 [0.68, 1.56], P = .89). However, repeated revascularization at 3 years was less frequent when STR ≥50% (12.4% vs 17.6%, adjusted HR = 0.74 [0.58, 0.95], P = .02). In contrast, MBG 2/3 vs 0/1 was not associated with reduced repeated revascularization (13.6% vs 14.1%, adjusted HR = 1.02 [0.79, 1.33], P = .85).
Conclusions:
In HORIZONS-AMI, MBG and STR after primary PCI were concordant in only 70% of patients and provided complementary prognostic information. Myocardial blush grade predicted long-term survival, whereas STR predicted freedom from repeated revascularization.
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