New York Methodist Hospital, Brooklyn, NY; Cardiovascular Research Foundation, New York, NY.
Am Heart J. 2013 Oct;166(4):676-83. doi: 10.1016/j.ahj.2013.07.025. Epub 2013 Sep 13.
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.
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.
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).
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.
ST 段回落（STR）和心肌灌注分级（MBG）在经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）后均具有预后价值。我们旨在阐明 MBG 和 STR 检测再灌注成功的指标在多大程度上不一致，并确定两者对长期预后的独立预后意义。
在 HORIZONS-AMI 研究中，对 2367 例行直接 PCI 的患者进行了 MBG 和 STR 的核心实验室评估。根据 MBG（分级 2/3 与 0/1）和 STR（≥50%与<50%）将患者分为 4 组。采用多变量模型确定 3 年时死亡和主要不良心脏事件的预测因素。
77.7%的患者达到 MBG 2/3 级，75.1%的患者达到 STR≥50%。765 例患者的 MBG 和 STR 结果不一致（30.9%）。多变量分析显示，MBG 2/3 级与 0/1 级相比，3 年死亡率更低（4.4%与 8.4%，校正后的危险比[HR]为 0.57[0.39,0.82]，P=0.003）。相比之下，STR≥50%与<50%与死亡率无关（5.1%与 5.9%，校正后的 HR=1.11[0.68,1.56]，P=0.89）。然而，3 年时再次血运重建的频率较低STR≥50%（12.4%与 17.6%，校正后的 HR=0.74[0.58,0.95]，P=0.02）。相比之下，MBG 2/3 级与 0/1 级与降低再次血运重建无关（13.6%与 14.1%，校正后的 HR=1.02[0.79,1.33]，P=0.85）。
在 HORIZONS-AMI 研究中，直接 PCI 后 MBG 和 STR 仅在 70%的患者中一致，提供了互补的预后信息。MBG 预测长期生存率，而 STR 预测免于再次血运重建。
