Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial
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 t...
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| Veröffentlicht in: | The American heart journal 2013-10, Vol.166 (4), p.676-683 |
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| creator | Brener, Sorin J., MD Dizon, Jose M., MD Mehran, Roxana, MD Guerchicoff, Alejandra, PhD Lansky, Alexandra J., MD Farkouh, Michael, MD Brodie, Bruce, MD Guagliumi, Giulio, MD Witzenbichler, Bernhard, MD Fahy, Martin, MS Parise, Helen, ScD Stone, Gregg W., MD |
| description | 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 |
| doi_str_mv | 10.1016/j.ahj.2013.07.025 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1443391730</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0002870313005097</els_id><sourcerecordid>1443391730</sourcerecordid><originalsourceid>FETCH-LOGICAL-c502t-1ace61dcebbe3a7616807c347a15cf48f78669094c8e9860410982e3d0869ca83</originalsourceid><addsrcrecordid>eNp9klGLEzEUhYMo7lr9Ab5IwBdfpiaTTJJREEpRt7BasOuLLyHN3GlTZyZrklnob_JPmrFVYR98CgnfOeGecxF6TsmcEipeH-Zmf5iXhLI5kXNSVg_QJSW1LITk_CG6JISUhZKEXaAnMR7yVZRKPEYXJSc1U1xeop9L39920MOQTDji2-B3g4_JWTwm17l0xL7F_dFbExpnOrztxrjHu2AawGZo8OamiLCb5DhA9F1W-QGbNkHIZq7_bQrBjskM4MeIrQ9-mF7dkJm7LMyCN3gxmO4YXcRt8D1Oe8BX6y-rb-vPm2LxaYVTyJ8_RY9a00V4dj5n6OuH9zfLq-J6_XG1XFwXtiJlKqixIGhjYbsFZqSgQhFpGZeGVrblqpVKiJrU3CqolSA8R6ZKYA1RorZGsRl6dfLNafwYISbdu2ih604jaMo5YzWVjGT05T304MeQZ8lUVVWScpnZGaInygYfY4BWn6PRlOipSX3QuUk9NamJ1LnJrHlxdh63PTR_FX-qy8DbEwA5ijsHQUfrYLDQuAA26ca7_9q_u6e2nRucNd13OEL8N4WOpSZ6M63StEmUEVLlFWO_AAdKxdY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1555714743</pqid></control><display><type>article</type><title>Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Brener, Sorin J., MD ; Dizon, Jose M., MD ; Mehran, Roxana, MD ; Guerchicoff, Alejandra, PhD ; Lansky, Alexandra J., MD ; Farkouh, Michael, MD ; Brodie, Bruce, MD ; Guagliumi, Giulio, MD ; Witzenbichler, Bernhard, MD ; Fahy, Martin, MS ; Parise, Helen, ScD ; Stone, Gregg W., MD</creator><creatorcontrib>Brener, Sorin J., MD ; Dizon, Jose M., MD ; Mehran, Roxana, MD ; Guerchicoff, Alejandra, PhD ; Lansky, Alexandra J., MD ; Farkouh, Michael, MD ; Brodie, Bruce, MD ; Guagliumi, Giulio, MD ; Witzenbichler, Bernhard, MD ; Fahy, Martin, MS ; Parise, Helen, ScD ; Stone, Gregg W., MD</creatorcontrib><description>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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2013.07.025</identifier><identifier>PMID: 24093847</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Cardiovascular ; Coronary Angiography ; Coronary Circulation - physiology ; Electrocardiography ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Laboratories ; Male ; Middle Aged ; Mortality ; Myocardial Infarction - diagnosis ; Myocardial Infarction - physiopathology ; Myocardial Infarction - surgery ; Postoperative Period ; Prognosis ; Recovery of Function ; Time Factors</subject><ispartof>The American heart journal, 2013-10, Vol.166 (4), p.676-683</ispartof><rights>Mosby, Inc.</rights><rights>2013 Mosby, Inc.</rights><rights>2013.</rights><rights>Copyright Elsevier Limited Oct 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-1ace61dcebbe3a7616807c347a15cf48f78669094c8e9860410982e3d0869ca83</citedby><cites>FETCH-LOGICAL-c502t-1ace61dcebbe3a7616807c347a15cf48f78669094c8e9860410982e3d0869ca83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1555714743?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24093847$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brener, Sorin J., MD</creatorcontrib><creatorcontrib>Dizon, Jose M., MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Guerchicoff, Alejandra, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>Farkouh, Michael, MD</creatorcontrib><creatorcontrib>Brodie, Bruce, MD</creatorcontrib><creatorcontrib>Guagliumi, Giulio, MD</creatorcontrib><creatorcontrib>Witzenbichler, Bernhard, MD</creatorcontrib><creatorcontrib>Fahy, Martin, MS</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><title>Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>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.</description><subject>Aged</subject><subject>Cardiovascular</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation - physiology</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - surgery</subject><subject>Postoperative Period</subject><subject>Prognosis</subject><subject>Recovery of Function</subject><subject>Time Factors</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9klGLEzEUhYMo7lr9Ab5IwBdfpiaTTJJREEpRt7BasOuLLyHN3GlTZyZrklnob_JPmrFVYR98CgnfOeGecxF6TsmcEipeH-Zmf5iXhLI5kXNSVg_QJSW1LITk_CG6JISUhZKEXaAnMR7yVZRKPEYXJSc1U1xeop9L39920MOQTDji2-B3g4_JWTwm17l0xL7F_dFbExpnOrztxrjHu2AawGZo8OamiLCb5DhA9F1W-QGbNkHIZq7_bQrBjskM4MeIrQ9-mF7dkJm7LMyCN3gxmO4YXcRt8D1Oe8BX6y-rb-vPm2LxaYVTyJ8_RY9a00V4dj5n6OuH9zfLq-J6_XG1XFwXtiJlKqixIGhjYbsFZqSgQhFpGZeGVrblqpVKiJrU3CqolSA8R6ZKYA1RorZGsRl6dfLNafwYISbdu2ih604jaMo5YzWVjGT05T304MeQZ8lUVVWScpnZGaInygYfY4BWn6PRlOipSX3QuUk9NamJ1LnJrHlxdh63PTR_FX-qy8DbEwA5ijsHQUfrYLDQuAA26ca7_9q_u6e2nRucNd13OEL8N4WOpSZ6M63StEmUEVLlFWO_AAdKxdY</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Brener, Sorin J., MD</creator><creator>Dizon, Jose M., MD</creator><creator>Mehran, Roxana, MD</creator><creator>Guerchicoff, Alejandra, PhD</creator><creator>Lansky, Alexandra J., MD</creator><creator>Farkouh, Michael, MD</creator><creator>Brodie, Bruce, MD</creator><creator>Guagliumi, Giulio, MD</creator><creator>Witzenbichler, Bernhard, MD</creator><creator>Fahy, Martin, MS</creator><creator>Parise, Helen, ScD</creator><creator>Stone, Gregg W., MD</creator><general>Mosby, Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20131001</creationdate><title>Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial</title><author>Brener, Sorin J., MD ; Dizon, Jose M., MD ; Mehran, Roxana, MD ; Guerchicoff, Alejandra, PhD ; Lansky, Alexandra J., MD ; Farkouh, Michael, MD ; Brodie, Bruce, MD ; Guagliumi, Giulio, MD ; Witzenbichler, Bernhard, MD ; Fahy, Martin, MS ; Parise, Helen, ScD ; Stone, Gregg W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-1ace61dcebbe3a7616807c347a15cf48f78669094c8e9860410982e3d0869ca83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Cardiovascular</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation - physiology</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - surgery</topic><topic>Postoperative Period</topic><topic>Prognosis</topic><topic>Recovery of Function</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brener, Sorin J., MD</creatorcontrib><creatorcontrib>Dizon, Jose M., MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Guerchicoff, Alejandra, PhD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>Farkouh, Michael, MD</creatorcontrib><creatorcontrib>Brodie, Bruce, MD</creatorcontrib><creatorcontrib>Guagliumi, Giulio, MD</creatorcontrib><creatorcontrib>Witzenbichler, Bernhard, MD</creatorcontrib><creatorcontrib>Fahy, Martin, MS</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brener, Sorin J., MD</au><au>Dizon, Jose M., MD</au><au>Mehran, Roxana, MD</au><au>Guerchicoff, Alejandra, PhD</au><au>Lansky, Alexandra J., MD</au><au>Farkouh, Michael, MD</au><au>Brodie, Bruce, MD</au><au>Guagliumi, Giulio, MD</au><au>Witzenbichler, Bernhard, MD</au><au>Fahy, Martin, MS</au><au>Parise, Helen, ScD</au><au>Stone, Gregg W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>166</volume><issue>4</issue><spage>676</spage><epage>683</epage><pages>676-683</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>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.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24093847</pmid><doi>10.1016/j.ahj.2013.07.025</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Cardiovascular Coronary Angiography Coronary Circulation - physiology Electrocardiography Female Follow-Up Studies Heart attacks Humans Laboratories Male Middle Aged Mortality Myocardial Infarction - diagnosis Myocardial Infarction - physiopathology Myocardial Infarction - surgery Postoperative Period Prognosis Recovery of Function Time Factors |
| title | Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: Analysis from the HORIZONS-AMI trial |
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