Key result
Operator and core laboratory assessments of angiographic reperfusion markers in STEMI demonstrated fair to moderate agreement, and both strongly predicted 3-year mortality.
Why the study?
Does operator assessment of angiographic reperfusion markers agree with core laboratory assessment and predict mortality in patients undergoing primary PCI for STEMI?
Observational (n=3,345)
Does operator assessment of angiographic reperfusion markers agree with core laboratory assessment and predict mortality in patients undergoing primary PCI for STEMI?
While operators tend to overestimate angiographic reperfusion success compared to core laboratories, both assessments remain strong predictors of long-term mortality in STEMI patients.
Answers are grounded in this paper and cite their sources.
Operator assessments may suffice for STEMI prognosis after primary PCI; leaves open whether core lab standardization improves trial precision.
BACKGROUND: Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush Grade (MBG) are important prognostic indicators before and after primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction; however, the concordance and relative prognostic utility of operator (Op) versus angiography core laboratory (ACL) assessed TIMI flow and MBG are unknown. METHODS AND RESULTS: Baseline and final Op and ACL TIMI flow and MBG assessment were compared from the Harmonizing Outcomes with RevascularIZatiON and Stents in AMI trial in 3345 patients undergoing primary PCI using Cohen's κ coefficient. κ Was highest for pre-PCI TIMI flow (0.51, representing moderate agreement) and lowest for post-PCI MBG (0.20, representing fair agreement). Discordance between Op and ACL for final TIMI flow (0 to 2 versus 3) occurred in 12.9% of patients and for final MBG (0 to 1 versus 2 to 3) in 22.4%. Among 415 patients with final TIMI flow 0 to 2 by ACL, Op scoring was TIMI flow 3 in 267 (64.3%). Similarly, among 706 patients with final MBG 0 to 1 by ACL, 563 (79.7%) were classified as MBG 2 to 3 by Op. Post-PCI TIMI 3 flow and MBG 2 to 3 strongly correlated with 3-year survival, as assessed by both Op and ACL (P<0.0001). Mortality was intermediate in patients in whom ACL and Op were discordant, without marked prognostic differences between the discordant groups. CONCLUSIONS: Op and ACL assessment of angiographic markers of reperfusion in ST-segment-elevation myocardial infarction demonstrates fair to moderate agreement. Op tended to favorably grade unfavorable ACL results. Nonetheless, both Op and ACL assessment of reperfusion strongly inform prediction of 3-year mortality.
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Brener et al. (2012) conducted an observational in ST-segment-elevation myocardial infarction (n=3,345). Operator assessment of angiographic reperfusion markers vs. Angiography core laboratory (ACL) assessment was evaluated on Concordance of TIMI flow and MBG assessment between operator and core laboratory, and correlation with 3-year survival (κ 0.20 to 0.51, p=<0.0001). Operator and core laboratory assessments of angiographic reperfusion markers in STEMI demonstrated fair to moderate agreement, and both strongly predicted 3-year mortality.
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