New insights in management and prognosis in acute myocardial infarction

The evaluation of new treatments during primary percutaneous coronary intervention (PCI) to reduce morbidity and mortality remains important in patients with ST-segment elevation myocardial infarction (STEMI). Studies evaluating the adjunctive treatments for STEMI patients ‘thrombus aspiration’ and the antiplatelet drug ‘abciximab’ have shown varying results in improving myocardial perfusion as a reflection of outcome. In our retrospective study, the use of thrombus aspiration was associated with improved myocardial perfusion in patients with large as well as with small thrombus burden. In the CICERO-trial we demonstrated that intracoronary administration of abciximab did not improve myocardial perfusion compared to intravenous administration.

Furthermore, we investigated retrospectively imaging and blood-based biomarkers to identify high risk STEMI patients who can benefit from adjunctive treatment. We described that the operator-scored imaging biomarker ‘myocardial blush grade’ after primary PCI was an independent predictor of 1-year all cause mortality. A score based on three blood-based biomarkers accurately identified risk for mortality. Finally, the value of N-terminal pro-brain natriuretic peptide in predicting left ventricular ejection fraction and infarct size is stronger when measured during follow-up compared to the values measured during hospitalization.