Transient ST-elevation myocardial infarction versus persistent ST-elevation myocardial infarction. An appraisal of patient characteristics and functional outcome.

Autor: Janssens GN; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands., Lemkes JS; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands., van der Hoeven NW; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands., van Leeuwen MAH; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Department of Cardiology, Isala Heart Center, Dokter van Heesweg 2, 8025AB Zwolle, the Netherlands., Everaars H; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands., van de Ven PM; Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081HV Amsterdam, the Netherlands., Brinckman SL; Department of Cardiology, Tergooi Hospital, Rijksstraatweg 1, 1261AN Blaricum, the Netherlands., Timmer JR; Department of Cardiology, Isala Heart Center, Dokter van Heesweg 2, 8025AB Zwolle, the Netherlands., Meuwissen M; Department of Cardiology, Amphia Hospital, Molengracht 21, 4818CK Breda, the Netherlands., Meijers JCM; Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Molecular and Cellular Hemostasis, Sanquin Research, Plesmanlaan 125, 1066CX Amsterdam, the Netherlands., van der Weerdt AP; Department of Cardiology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934AD Leeuwarden, the Netherlands., Ten Cate TJF; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands., Piek JJ; Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands., von Birgelen C; Department of Cardiology, Medisch Spectrum Twente, Koningsplein 1, 7512KZ Enschede, the Netherlands., Diletti R; Department of Cardiology, Erasmus MC, 's Gravendijkwal 230, 3015CE Rotterdam, the Netherlands., Escaned J; Cardiovascular Institute, Hospital Clínico San Carlos IDISSC, Calle del Profesor Martín Lagos, S/N, 28040 Madrid, Spain., van Rossum AC; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands., Nijveldt R; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands., van Royen N; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands. Electronic address: niels.vanroyen@radboudumc.nl.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2021 Aug 01; Vol. 336, pp. 22-28. Date of Electronic Publication: 2021 May 15.
DOI: 10.1016/j.ijcard.2021.05.018
Abstrakt: Background: Up to 24% of patients presenting with ST-elevation myocardial infarction (STEMI) show resolution of ST-elevation and symptoms before revascularization. The mechanisms of spontaneous reperfusion are unclear. Given the more favorable outcome of transient STEMI, it is important to obtain further insights in differential aspects.
Methods: We compared 251 patients who presented with transient STEMI (n = 141) or persistent STEMI (n = 110). Clinical angiographic and laboratory data were collected at admission and in subset of patients additional index hemostatic data and at steady-state follow-up. Cardiac magnetic resonance imaging (CMR) was performed at 2-8 days to assess myocardial injury.
Results: Transient STEMI patients had more cardiovascular risk factors than STEMI patients, including more arterial disease and higher cholesterol values. Transient STEMI patients showed angiographically more often no intracoronary thrombus (41.1% vs. 2.7%, P < 0.001) and less often a high thrombus burden (9.2% vs. 40.0%, P < 0.001). CMR revealed microvascular obstruction less frequently (4.2% vs. 34.6%, P < 0.001) and smaller infarct size [1.4%; interquartile range (IQR), 0.0-3.7% vs. 8.8%; IQR, 3.9-17.1% of the left ventricle, P < 0.001] with a better preserved left ventricular ejection fraction (57.8 ± 6.7% vs. 52.5 ± 7.6%, P < 0.001). At steady state, fibrinolysis was higher in transient STEMI, as demonstrated with a reduced clot lysis time (89 ± 20% vs. 99 ± 25%, P = 0.03).
Conclusions: Transient STEMI is a syndrome with less angiographic thrombus burden and spontaneous infarct artery reperfusion, resulting in less myocardial injury than STEMI. The presence of a more effective fibrinolysis in transient STEMI patients may explain these differences and might provide clues for future treatment of STEMI.
Competing Interests: Declaration of Competing Interest Prof. dr. van Royen reports research grants from AstraZeneca, Abbott, Philips, Biotronik and a honorarium from Medtronic. Dr. Lemkes reports grants from Biotronik and Astrazeneca, during the conduct of the study. Prof. dr. Piek reports non-financial support from Abbott Vascular as member medical advisory board, personal fees and non-financial support from Philips/Volcano as Consultant, outside the submitted work. Prof. dr. von Birgelen reports institutional research grants from Abbott Vascular, Biotronik, Boston Scientific and Medtronic, outside the submitted work. Dr. van Leeuwen reports grants from AstraZeneca, grants from Top Sector Life Sciences & Health, during the conduct of the study. Dr. Escaned reports consultancies work for Philips, outside of the submitted work. All other authors declare no competing interests with regards to the study.
(Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: