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

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:336

Article

Janssens, Gladys N.¹  Lemkes, Jorrit S.¹  van der Hoeven, Nina W.¹  van Leeuwen, Maarten A. H.^1,2  Everaars, Henk¹  van de Ven, Peter M.³  Brinckman, Stijn L.⁴  Timmer, Jorik R.²  Meuwissen, Martijn⁵  Meijers, Joost C. M.^6,7  van der Weerdt, Arno P.⁸  Cate, Tim J. F. ten⁹  Piek, Jan J.¹⁰  von Birgelen, Clemens¹¹  Diletti, Roberto¹²  Escaned, Javier¹³  van Rossum, Albert C.¹  Nijveldt, Robin^1,9  van Royen, Niels^1,9 

[1] Vrije Univ Amsterdam, Amsterdam UMC, Dept Cardiol, Amsterdam Cardiovasc Sci, Boelelaan 1117, NL-1081HV Amsterdam, Netherlands

[2] Dept Cardiol, Isala Heart Ctr, Dokter Heesweg 2, NL-8025AB Zwolle, Netherlands

[3] Vrije Univ Amsterdam, Amsterdam UMC, Dept Epidemiol & Biostat, Boelelaan 1089a, NL-1081HV Amsterdam, Netherlands

[4] Tergooi Hosp, Dept Cardiol, Rijksstraatweg 1, NL-1261AN Blaricum, Netherlands

[5] Amphia Hosp, Dept Cardiol, Molengracht 21, NL-4818CK Breda, Netherlands

[6] Univ Amsterdam, Amsterdam UMC, Dept Expt Vasc Med, Amsterdam Cardiovasc Sci, Meibergdreef 9, NL-1105AZ Amsterdam, Netherlands

[7] Dept Mol & Cellular Hemostasis, Sanquin Res, Plesmanlaan 125, NL-1066CX Amsterdam, Netherlands

[8] Dept Cardiol, Med Ctr Leeuwarden, Henri Dunantweg 2, NL-8934AD Leeuwarden, Netherlands

[9] Radboud Univ Nijmegen Med Ctr, Dept Cardiol, Geert Grootepl Zuid 10, NL-6525GA Nijmegen, Netherlands

[10] Univ Amsterdam, Amsterdam UMC, Dept Cardiol, Meibergdreef 9, Amsterdam, Netherlands

[11] Dept Cardiol, Med Spectrum Twente, Koningspl 1, NL-7512KZ Enschede, Netherlands

[12] Dept Cardiol, Erasmus MC, S Gravendijkwal 230, NL-3015CE Rotterdam, Netherlands

[13] Hosp Clin San Carlos IDISSC, Cardiovasc Inst, Calle Profesor Martin Lagos,S-N, Madrid 28040, Spain

关键词: Transient ST-elevation myocardial infarction;    ST-elevation myocardial infarction;    Culprit vessel patency;    Cardiac magnetic resonance imaging;    Fibrinolysis;   

DOI  :  10.1016/j.ijcard.2021.05.018

来源: Elsevier

【 摘 要 】

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 as-pects. 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 arte-rial 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 isa syndrome with less angiographic thrombus burden and spontaneous infarct ar-tery 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. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

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