Cohort study
Biomarkers of Thrombotic Status Predict Spontaneous Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction
- Prospective cohort study
Authors' conclusion
We demonstrate a novel hematological signature in STEMI patients with spontaneous reperfusion, namely, decreased platelet reactivity and faster endogenous fibrinolysis, relating to smaller infarcts and improved survival.
Study context
- Population
- STEMI patients, blood tested pre-PCI for point-of-care occlusion times (OT) and endogenous lysis times (LT)
- Participants
- 801 patients
- Exposure
- Spontaneous reperfusion vs no spontaneous reperfusion
Main finding
As reported in the abstract
Thrombotic profile (OT, LT) by spontaneous reperfusion · pre-PCI
| Group | OT | LT |
|---|---|---|
| Spontaneous reperfusion | 435 seconds | 1,257 seconds |
| No spontaneous reperfusion | 366 seconds | 1,616 seconds |
- Spontaneous reperfusion vs No spontaneous reperfusion: P < 0.001 — longer OT
- Spontaneous reperfusion vs No spontaneous reperfusion: P < 0.001 — shorter LT
Observational data: associations, not effects.
Further findings
MACE (death, MI or stroke) · 4 years
P = 0.013
- MACE (death, MI or stroke) — Spontaneous reperfusion with complete ST-segment resolution vs without
- 1.5% vs 10.1%; P = 0.029
Prediction of spontaneous reperfusion (AUC)
- AUC for LT
- 0.707 (95% CI 0.661-0.753)
- AUC for OT
- 0.629 (95% CI 0.581-0.677)
- LT superior to OT
OT and LT, complete vs partial ST-segment resolution (spontaneous reperfusion subgroup)
- Longer OT with complete ST-segment resolution
- P = 0.002
- Shorter LT with complete ST-segment resolution
- P < 0.001
Clinical characteristics, pain-to-angiography times
- Spontaneous reperfusion unrelated to clinical characteristics or pain-to-angiography times
Original publication
Biomarkers of Thrombotic Status Predict Spontaneous Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol. Published 16 May 2023. doi:10.1016/j.jacc.2023.03.388
Summarised from the published abstract; every number is checked against it