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ST–segment resolution (STR) and myocardial blush grade (MBG) both strongly correlate with prognosis after primary PCI in STEMI. To identify the frequency of concordant and discordant classes of MBG and STR and the prognostic significance of each on 3–year mortality and MACE in the HORIZONS–AMI trial
3,602 patients were randomized to bivalirudin or heparin and a glycoprotein IIb/IIIa inhibitor and to paclitaxel–eluting stents (PES) or identical bare–metal stents (BMS). By core lab analysis, successful myocardial reperfusion was defined as MBG grades 2/3. STR was categorized as present if ≥50% of the sum of ST–elevation present on the baseline ECG had resolved by 60 minutes after PCI. 4 groups were identified: MBG 2/3 and STR ≥50%, MBG 2/3 and STR <50%, MBG 0/1 and STR ≥50%, MBG 0/1 and STR <50%. A multivariable model was constructed to identify predictors of death and MACE at 3 years.
Both MBG and STR were available in 2,367 patients. MBG 2/3 was achieved in 1,838 patients (77.7%). Patients with MBG 2/3 vs. 0/1 had significantly lower mortality at 3 years (4.4% vs. 8.4%, P=0.0002). STR ≥50% was achieved in 1,777 patients (75.1%). Mortality in the ≥50% and <50% STR was 5.1% vs. 5.9%, respectively, P=0.45. There was significantly less repeat revascularization (12.4% vs. 17.6%, P<0.001) in the ≥50% STR group. There were 1,425 (54.6%), 413 (22.7%), 352 (13.5%), and 177 (9.2%) in the 4 groups respectively (32.3% discordant rate). By multivariable analysis, MBG 2/3 was associated with a 38% reduction in mortality (HR=0.62 [0.41, 0.94], P=0.02). STR was not independently related to death (P=0.56). Neither STR nor MBG predicted MACE at 3 years. Classifying STR as <30%, 30–70% and >70% did not change significantly the overall results, although STR>70% was marginally associated with lower MACE (HR=0.74 [0.56–0.99], P=0.044), due to lower rates of reavascularization.
In the HORIZONS–AMI trial, MBG and STR were found to be concordant in only 67.7% of patients, and provided complementary prognostic information. MBG predicted long–term mortality, whereas STR predicted late revascularization.
West, Room 2001
Monday, March 11, 2013, 8:45 a.m.–8:55 a.m.
Session Title: ST–Elevation Myocardial Infarction and High–Risk PCI
Abstract Category: 37. TCT@ACC–i2: Angiography and Interventional Aspects of CT/MR
Presentation Number: 2908–7
- 2013 American College of Cardiology Foundation