Shavadia JS, Granger CB, Alemayehu W, et al. - Given that although epicardial flow is restored after primary percutaneous coronary intervention (PPCI), variability still exist in microvascular reperfusion as reflected by ST‐elevation resolution (ST‐ER) resolution and there is a lack of clarity about its pathophysiology, so, researchers examined links between serum biomarkers (n = 91) drawn prior to PPCI clustered into 14 pathobiologic processes (including NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide] as an independent cluster), and ST‐ER resolution ≥ 50% vs < 50%; and 90‐day composite of mortality, shock, and heart failure. Per findings, suboptimal ST‐ER was common despite attaining post‐PPCI TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow. A strong correlation of the cluster of platelet activation proteins as well as NT‐proBNP, with suboptimal ST‐ER, was also revealed. Results showed an independent link of NT‐proBNP with 90‐day outcomes. This work affords further understanding of the pathophysiology of microvascular reperfusion in ST‐segment–elevation myocardial infarction, as well as suggests new pre‐PPCI risk targets potentially amenable to enhancing tissue‐level reperfusion post-PPCI.