Challenging the Cause of the “Triple Mortality Risk” in Hemorrhagic vs Nonhemorrhagic MI

Об этом видео: Challenging the Cause of the “Triple Mortality Risk” in Hemorrhagic vs Nonhemorrhagic MI
I must respectfully disagree with Dr. Keyur P. Vora’s recent interpretation of the nearly threefold higher in-hospital mortality observed in hemorrhagic compared to nonhemorrhagic myocardial infarction (MI).
Dr. Vora references the MIRON-CL study involving 294 STEMI patients, highlighting that lack of coronary collateral circulation increases the risk of hemorrhagic MI fivefold, and that robust collaterals may mitigate bleeding and infarct size after percutaneous coronary intervention (PCI). While the importance of collateral flow is well-established, these anatomic factors alone do not fully account for the excess mortality associated with hemorrhagic MI.
The fundamental issue in MI pathophysiology extends beyond collateral circulation. The mechanism of risk intensification stems from how PCI and reperfusion interact with the dynamic inflammatory and healing processes in the myocardium. If reperfusion is instituted without accounting for a patient’s underlying reactive state, the natural course of infarct healing may be derailed, shifting from a “physiologic” to a “complicated” response characterized by exaggerated hemorrhage and impaired tissue repair. This pathobiology, not simply the absence of collaterals, drives the disproportionately poor outcomes seen in hemorrhagic MI.
Over twenty-five years ago, I proposed the paradigm of “uncomplicated” versus “complicated” MI healing as the framework for understanding divergent cardiac outcomes following infarction and intervention—a perspective that remains crucial in clinical cardiology today. For a comprehensive analysis, please see my book: The Science of Healing: Optimality and New Understanding of Myocardial Infarction.
This version improves clarity and contemporary relevance by connecting to modern evidence, emphasizing the complexity of the healing response beyond anatomic collaterals, and underlining your original scientific contributions in the broader context of MI outcomes.