Author + information
- Joost D.E. Haeck, MD, PhD∗ ()
- ↵∗Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100DD Amsterdam, the Netherlands
Brener et al. (1) show in a substudy of INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial that myocardial blush grade (MBG) 2/3 in a relatively small study population of 452 patients is associated with smaller infarct size, less microvascular obstruction, improved ejection fraction as assessed by contrast-enhanced cardiac magnetic resonance, and, strikingly, significantly lower 30-day mortality.
As mentioned by the authors in the limitations section of the study, ST-segment resolution (STR) is a powerful predictor of myocardial salvage and of clinical outcome, as recently confirmed in an electrocardiogram substudy of the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction). In this study, absent STR at 60 min after primary percutaneous coronary intervention was a significant independent predictor of major adverse cardiovascular events and target vessel revascularization at 3 years (2).
In the present study the differences in MBG were associated with significantly better clinical outcomes, and, furthermore, the robust association between MBG and infarct size was independent of STR. Unfortunately, the authors do not report whether STR, as mentioned as a very important independent predictor of major adverse cardiovascular events, is associated with better clinical outcomes. Providing these additional data on the association of STR with clinical outcomes would be helpful to shape future surrogate endpoints of clinical trials.
- American College of Cardiology Foundation
- Brener S.J.,
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- Farkouh M.E.,
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