Clinical InvestigationRelationship between therapeutic effects on infarct size in acute myocardial infarction and therapeutic effects on 1-year outcomes: A patient-level analysis of randomized clinical trials
Section snippets
Methods
As previously described,9 we combined patient-level data from 10 randomized clinical trials that tested various treatments during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).10., 11., 12., 13., 14., 15., 16., 17., 18., 19. Patients were included in the current database if infarct size was measured by either CMR or technetium (Tc)–99 m-sestamibi SPECT within 1 month (outside window 37 days), and if clinical follow-up was reported for ≥6
Results
Table I shows the baseline characteristics for each study, and all studies pooled, in each of the two analysis datasets. The pooled population at study entry (dataset 2, n = 2679) included 77% men, average age 61, with prior MI in 7%, diabetes in 18%, and left main or three-vessel coronary artery disease in 14%. Infarct size was assessed at a median of 4 days after STEMI.
One-year clinical outcomes, including the differences between the treatment and control groups for heart failure and mortality,
Discussion
The present study of patient-level data from 10 randomized controlled trials of treatment interventions during primary PCI in patients with STEMI suggests that therapeutic effects on infarct size, as measured by noninvasive CMR or SPECT imaging within days after treatment, is related in direction and magnitude to the longer-term (one-year) therapeutic effect on hospitalization for heart failure. In contrast, no such relationship was present between the treatment effect on infarct size and
Disclosures
Dr. Stone reports serving as a consultant for TherOx. Dr Ohman reports receiving research grants from Daiichi Sankyo, Eli Lilly & Company, Gilead Sciences, and Janssen Pharmaceuticals; serving as a consultant for Abiomed, AstraZeneca, Biotie, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly & Company, Faculty Connection, Gilead Sciences, Janssen Pharmaceuticals, Merck, Stealth Peptides, The Medicines Company, and WebMD. The other authors report no disclosures.
Acknowledgement
The authors thank Cathy Griffin for her expert manuscript preparation.
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Wilbert S. Aronow, MD served as guest editor for this article.