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

Autor: Maarten A.H. van Leeuwen, Albert C. van Rossum, Martijn Meuwissen, Tim ten Cate, Peter M. van de Ven, Stijn L. Brinckman, Gladys N. Janssens, Jan J. Piek, Arno P. van der Weerdt, Jorrit S. Lemkes, Clemens von Birgelen, Joost C. M. Meijers, Javier Escaned, Jorik R. Timmer, Robin Nijveldt, Nina W. van der Hoeven, Henk Everaars, Niels van Royen, Roberto Diletti
Přispěvatelé: Cardiology, Experimental Vascular Medicine, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, Epidemiology and Data Science, APH - Methodology, VU University medical center
Rok vydání: 2021
Předmět:
medicine.medical_specialty
medicine.medical_treatment
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
030204 cardiovascular system & hematology
Revascularization
Ventricular Function
Left
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Interquartile range
Cardiac magnetic resonance imaging
Internal medicine
Fibrinolysis
medicine
Humans
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Ejection fraction
medicine.diagnostic_test
business.industry
Culprit vessel patency
Transient ST-elevation myocardial infarction
Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16]
Stroke Volume
medicine.disease
Magnetic Resonance Imaging
medicine.anatomical_structure
ST-elevation myocardial infarction
surgical procedures
operative
Treatment Outcome
Ventricle
Cardiology
ST Elevation Myocardial Infarction
Cardiology and Cardiovascular Medicine
business
Artery
Zdroj: International Journal of Cardiology, 336, 22-28. Elsevier Ireland Ltd
International Journal of Cardiology, 336, 22-28
International journal of cardiology, 336, 22-28. Elsevier Ireland Ltd
Janssens, G N, Lemkes, J S, van der Hoeven, N W, van Leeuwen, M A H, Everaars, H, van de Ven, P M, Brinckman, S L, Timmer, J R, Meuwissen, M, Meijers, J C M, van der Weerdt, A P, ten Cate, T J F, Piek, J J, von Birgelen, C, Diletti, R, Escaned, J, van Rossum, A C, Nijveldt, R & van Royen, N 2021, ' Transient ST-elevation myocardial infarction versus persistent ST-elevation myocardial infarction. An appraisal of patient characteristics and functional outcome ', International Journal of Cardiology, vol. 336, pp. 22-28 . https://doi.org/10.1016/j.ijcard.2021.05.018
International Journal of Cardiology, 336, pp. 22-28
ISSN: 1874-1754
0167-5273
Popis: Contains fulltext : 235369.pdf (Publisher’s version ) (Open Access) 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.
Databáze: OpenAIRE
Externí odkaz: