Usefulness of echocardiographic advanced mechanical analysis for MACE prediction in STEMI: is there new evidence in the pharmacoinvasive era?

The cornerstone of treatment in ST elevation myocardial infarction (STEMI) is to achieve early reperfusion, either with pharmaco-invasive strategy (PhI) or primary percutaneous coronary intervention (PCI). No meaningful differences in clinical outcomes were shown with either reperfusion strategy. TheTAPSE/sPAP ratio as an echocardiographic estimation of RV/PA coupling has a prognostic role in multiple cardiovascular conditions, notwithstanding, its clinical role across reperfusion strategies in STEMI is scarce. Global longitudinal Strain (GLS) provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. Both are part of modern non-invasive indices of cardiac function. Their interaction in determining prognosis in STEMI patients is not well established.

To assess the performance of advanced echocardiographic ventricular analysis and risk of MACE following an ACS, as a proof -of-concept explanation of the non-inferiority clinical results of the PhI strategy compared to primary PCI.

We retrospectively enrolled 160 patients diagnosed with STEMI and ischemic time <24h, transthoracic echocardiography study was done by specialists on admission and the follow up was for 700 days. There were 2 groups according to the reperfusion strategy (PhI and PCI), in both cases TAPSE/sPAP was >0.32 mm/mmHg and GLS >15%. Kaplan-Meier methods with log-rank tests were employed to assess the presence of MACE defined as heart failure, bleeding, stroke, shock and death.

At final analysis 87.5% were male, the median age was 58 years, and 77% were treated by pharmacoinvasive strategy, 47.5% had hypertension, 41.2% had diabetes, 45% was anterior wall myocardial infarction, 95% had TAPSE/sPAP ratio >=0.32 mm/mmHg, 74.7% had GLS >-15% and 37.5% presented MACE. Kaplan-Meier curves and log rank test showed no significant differences for presence of MACE between patients with normal values of RV/PA (>0.32mm/mmHg) and optimal GLS (>-15%) with a p-value<0.384 in both groups of reperfusion strategy.