title: Prognostic value of myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction.
abstract: Myocardial salvage assessed by (99m)Tc-sestamibi scintigraphy is a marker of myocardial tissue reperfusion in patients with acute myocardial infarction. The prognostic value of myocardial salvage index in patients with acute myocardial infarction after reperfusion therapy has not, however, been investigated.
  
  
  METHODS
  We analyzed 765 patients with acute myocardial infarction randomized to treatment by coronary stenting (383 patients), primary coronary angioplasty (251 patients), or thrombolysis (131 patients) in the setting of 3 randomized trials. Initial (before reperfusion therapy) and follow-up (7-14 d after reperfusion therapy) scintigraphic examinations were performed to assess the initial perfusion defect, final infarct size, and salvage index. Patients were categorized into 2 groups defined by the median salvage index (0.5): the group with salvage index < 0.5 (374 patients) and the group with salvage index >or= 0.5 (391 patients). The primary endpoint of the study was mortality at 6 mo after the index event.
  
  
  RESULTS
  Six-month mortality was 5.1% (19 deaths) in the group with salvage index < 0.5, compared with 1.0% (4 deaths) in the group with salvage index >or= 0.5 (odds ratio, 5.1; 95% confidence interval, 1.9-13.3; P = 0.001). Salvage index (median [25th, 75th percentiles] was significantly smaller in nonsurvivors than in survivors (0.19 [0.05, 0.37] vs. 0.50 [0.26, 0.80], P = 0.0004). The Cox proportional hazards model showed that myocardial salvage index (P = 0.0007), initial perfusion defect (P = 0.0007), and age (P = 0.04) were independently associated with 6-mo mortality.
  
  
  CONCLUSIONS
  Myocardial salvage achieved by reperfusion therapy predicts mortality in patients with acute myocardial infarction. Our findings support the use of salvage index as a surrogate of mortality in clinical trials designed to test the efficacy of reperfusion therapies among patients with acute myocardial infarction.
authors.affiliation: Deutsches Herzzentrum, Munich, Germany.
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Helmut
authors.initials: H
authors.lastname: Schühlen
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekolla
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D015607:Stents; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi