Correlation between markers of reperfusion and mortality in ST-elevation myocardial infarction: a systematic review
Sudhakar Sattur1, Bilal Sarwar, Terrence J Sacchi
1Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, New York, USA. sjb9005@nyp.org.
Insights
Improved reperfusion markers in ST-elevation myocardial infarction (STEMI) correlate with better survival. Angiographic and electrocardiographic markers of reperfusion significantly predict both early and late mortality in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Early reperfusion is critical for improving outcomes in ST-elevation myocardial infarction (STEMI).
- Assessing reperfusion effectiveness can be done through angiographic measures like Thrombolysis in Myocardial Infarction (TIMI) flow grade and myocardial blush grade (MBG), or electrocardiographic markers such as ST-segment recovery (STR).
Purpose of the Study:
- To investigate the correlation between early and late mortality rates and various markers of reperfusion in patients with STEMI.
- To determine the predictive value of different reperfusion assessment methods on STEMI patient survival.
Main Methods:
- A systematic search of randomized clinical trials over the last decade reporting STEMI reperfusion markers and clinical outcomes.
- Utilized a generalized estimating equation (GEE) model with logistic regression to analyze the association between reperfusion markers and 30-day and 365-day mortality.
- Conducted random-effects meta-analysis for studies comparing mortality based on myocardial blush grade (MBG) categories.
Main Results:
- Analysis of 44 studies involving 19,955 patients revealed that final TIMI 3 flow was achieved in 87%, MBG 2 or 3 in 70%, and complete STR in 66%.
- Significant correlations were found between TIMI 3 flow, MBG 2/3, STR, and 1-year mortality after adjusting for clinical factors (P=.03, P=.02, P=.04, respectively).
- Patients with MBG 0/1 experienced substantially higher mortality (RR=2.14 at 30 days, RR=1.49 at 1 year) compared to those with MBG 2/3.
Conclusions:
- Better reperfusion, assessed by angiographic and electrocardiographic markers, is significantly associated with improved survival in STEMI patients.
- These findings highlight the importance of optimizing reperfusion strategies to enhance long-term outcomes in STEMI management.
Objective:
To correlate early and late mortality with markers of reperfusion in ST-elevation myocardial infarction (STEMI).
Background:
Early reperfusion improves STEMI outcomes. Reperfusion can be assessed using angiographic (Thrombolysis in Myocardial Infarction [TIMI] flow grade or myocardial blush grade [MBG]) or electrocardiographic markers (ST-segment recovery (STR).
Methods:
We searched electronic databases for all STEMI randomized clinical studies from the last decade reporting markers of reperfusion and clinical outcome. We used a generalized estimating equation (GEE) model with logistic regression link in order to assess the correlation between each marker of reperfusion and mortality at 30 and 365 days. We also performed random effect meta-analysis for selected studies comparing mortality for specific categories of MBG.
Results:
We identified 44 studies with 19,955 patients. Final TIMI 3 flow was achieved in 87%, 70% had MBG 2 or 3, and 66% had complete STR. Average 30-day and 1-year mortality was 2.97 ± 2.34% and 4.11 ± 2.52%, respectively. Adjusting (study level) for age, diabetes, chronic kidney disease, infarct location, ejection fraction, and female sex, there was significant correlation between each of the three markers and 1-year mortality (P=.03 for TIMI 3; P=.02 for MBG 2 or 3; and P=.04 for STR). In nearly 6000 patients, there was substantial excess mortality in those with MBG 0/1 compared with MBG 2/3 (relative risk = 2.14 [1.65-2.77] with P<.001 at 30 days; relative risk = 1.49 [1.3-1.7] and P<.001 at 1 year).
Conclusion:
After correcting for clinical factors known to affect outcome, there was a significant correlation between survival and better reperfusion.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...