Despite significant advances in the treatment of ST elevation myocardial infarction (STEMI), there remains a significant short-term and long-term increased mortality risk. Risk stratification to target those who may benefit from more intensive therapy postrevascularisation therefore remains an important goal. Risk stratification models in acute coronary syndrome (ACS) have been researched for many years, but few risk scores have been developed and validated specifically for the STEMI population. Only 27% of the cohort for the Global Registry of Acute Coronary Events (GRACE) score was derived from those undergoing percutaneous intervention (PCI), and the GRACE score performs less accurately in those undergoing PCI compared with medical therapy. Nevertheless European1 (but not American2) guidelines recommend its use for clinical risk stratification in the STEMI cohort. Risk scores derived specifically for STEMI include the Global Utilization of Streptokinase and Tissue plasminogen activator to treat Occluded arteries (GUSTO) risk score, which was developed in the era of thrombolysis, while risk scores assessing mortality in primary PCI patients include the Primary Angioplasty in Myocardial Infarction (PAMI) risk score, Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score, Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) score, Soroka Acute Myocardial Infarction (SAMI) score, and the Zwolle risk score. Coelho-Lima and colleagues3 examine the prognostic value of troponin specifically in the STEMI population, a group where troponin is not used to guide initial treatment. Their major findings are that admission troponin, but not troponin measured 12 hours post-reperfusion, was a significant independent predictor of both inpatient or overall mortality, with a median follow-up time of over 4 years. The authors are to be commended for this large retrospective study—in particular, the clinical …

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ST 段抬高型心肌梗死后是否需要早期风险分层？

尽管 ST 段抬高型心肌梗死 (STEMI) 的治疗取得了重大进展，但短期和长期死亡率风险仍然显着增加。因此，针对可能受益于血运重建后更强化治疗的患者进行风险分层仍然是一个重要目标。急性冠状动脉综合征 (ACS) 的风险分层模型已经研究多年，但很少有专门针对 STEMI 人群开发和验证的风险评分模型。全球急性冠脉事件注册 (GRACE) 评分队列中只有 27% 来自接受经皮介入 (PCI) 的患者，与药物治疗相比，GRACE 评分在接受 PCI 的患者中的准确度较低。尽管如此，欧洲 1（但不是美国 2）指南推荐将其用于 STEMI 队列中的临床风险分层。专门针对 STEMI 得出的风险评分包括全球利用链激酶和组织纤溶酶原激活剂治疗闭塞动脉 (GUSTO) 风险评分，该评分是在溶栓时代开发的，而评估直接 PCI 患者死亡率的风险评分包括心肌主要血管成形术梗塞 (PAMI) 风险评分、受控阿昔单抗和降低晚期血管成形术并发症 (CADILLAC) 风险评分的设备调查、Pexelizumab 评估急性心肌梗塞 (APEX-AMI) 评分、Soroka 急性心肌梗塞 (SAMI) 评分和 Zwolle 风险分数。Coelho-Lima 及其同事 3 专门研究了肌钙蛋白在 STEMI 人群中的预后价值，不使用肌钙蛋白指导初始治疗的组。他们的主要发现是入院时肌钙蛋白，而不是再灌注后 12 小时测量的肌钙蛋白，是住院或总死亡率的重要独立预测因子，中位随访时间超过 4 年。作者因这项大型回顾性研究而受到赞扬——尤其是临床……