Infarct size assessed within 1 month after primary PCI for STEMI was strongly associated with subsequent mortality (HR 1.19 per 5% increase; 95% CI 1.18-1.20; p<0.0001) and HF hospitalization.
Meta-Analysis (n=2,632)
Yes
Is infarct size assessed early after primary PCI associated with subsequent all-cause mortality, reinfarction, and hospitalization for heart failure in patients with STEMI?
Infarct size measured within 1 month after primary PCI for STEMI is strongly and independently associated with 1-year all-cause mortality and heart failure hospitalization.
Effect estimate: HR 1.19 (95% CI 1.18-1.20)
p-value: p=< 0.0001
BACKGROUND: Prompt reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) reduces infarct size and improves survival. However, the intuitive link between infarct size and prognosis has not been convincingly demonstrated in the contemporary era. OBJECTIVES: This study sought to determine the strength of the relationship between infarct size assessed early after primary percutaneous coronary intervention (PCI) in STEMI and subsequent all-cause mortality, reinfarction, and hospitalization for heart failure. METHODS: We performed a pooled patient-level analysis from 10 randomized primary PCI trials (total 2,632 patients) in which infarct size was assessed within 1 month after randomization by either cardiac magnetic resonance (CMR) imaging or technetium-99m sestamibi single-photon emission computed tomography (SPECT), with clinical follow-up for ≥ 6 months. RESULTS: Infarct size was assessed by CMR in 1,889 patients (71.8%) and by SPECT in 743 patients (28.2%). Median (25th, 75th percentile) time to infarct size measurement was 4 days (3, 10 days) after STEMI. Median infarct size (% left ventricular myocardial mass) was 17.9% (8.0%, 29.8%), and median duration of clinical follow-up was 352 days (185, 371 days). The Kaplan-Meier estimated 1-year rates of all-cause mortality, reinfarction, and HF hospitalization were 2.2%, 2.5%, and 2.6%, respectively. A strong graded response was present between infarct size (per 5% increase) and subsequent mortality (Cox-adjusted hazard ratio: 1.19 95% confidence interval: 1.18 to 1.20; p < 0.0001) and hospitalization for heart failure (adjusted hazard ratio: 1.20 95% confidence interval: 1.19 to 1.21; p < 0.0001), independent of age, sex, diabetes, hypertension, hyperlipidemia, current smoking, left anterior descending versus non-left anterior descending infarct vessel, symptom-to-first device time, and baseline TIMI (Thrombolysis In Myocardial Infarction) flow 0/1 versus 2/3. Infarct size was not significantly related to subsequent reinfarction. CONCLUSIONS: Infarct size, measured by CMR or technetium-99m sestamibi SPECT within 1 month after primary PCI, is strongly associated with all-cause mortality and hospitalization for HF within 1 year. Infarct size may, therefore, be useful as an endpoint in clinical trials and as an important prognostic measure when caring for patients with STEMI.
“With primary PCI, we’ve become very successful and efficient at opening the infarct-related artery. We’re not as good at salvaging myocardium and we end up with large infarcts in a lot of patients, and that leads to death and heart failure.”
Stone et al. (Fri,) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=2,632). Infarct size (per 5% increase) was evaluated on All-cause mortality (HR 1.19, 95% CI 1.18-1.20, p=< 0.0001). Infarct size assessed within 1 month after primary PCI for STEMI was strongly associated with subsequent mortality (HR 1.19 per 5% increase; 95% CI 1.18-1.20; p<0.0001) and HF hospitalization.
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