In-hospital mortality in hemorrhagic myocardial infarction

Abstract Background In-hospital mortality among revascularized STEMI patients remains high. Intramyocardial hemorrhage (IMH) post-PCI, a severe form of reperfusion injury, is a key predictor of adverse outcomes, yet its immediate impact on mortality is underrecognized due to the lack of real-time diagnostic tools for hemorrhagic myocardial infarction (hMI). Methods In the MIRON-TROP multicenter trial (n=207), we evaluated whether post-PCI high-sensitivity cardiac troponin I (hs-cTn-I) can serve as a rapid and reliable biomarker for hMI. We further analyzed a large STEMI registry (n=6180) to assess in-hospital mortality rates among patients diagnosed with hMI using hs-cTn-I levels. Results Within the first hour post-PCI, hs-cTn-I identified hMI with 94% sensitivity, 89% specificity, and an AUC of 0.95. hMI emerged as the most significant predictor of in-hospital mortality (Adjusted OR = 2.14, p0.001), outperforming traditional risk factors such as age (Adjusted OR = 1.02, p0.001), while sex, comorbidities, and pre-PCI troponin failed to predict mortality as strongly. Conclusion Early detection of hemorrhagic MI using post-PCI hs-cTn-I offers a powerful new tool for clinicians, doubling the ability to predict in-hospital mortality. This biomarker could transform acute STEMI care, enabling targeted interventions to prevent early deaths in high-risk patients.MIRON-TROP Clinical Trial Design