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

Gladys N. Janssens, Jorrit S. Lemkes, Nina W. van der Hoeven, Maarten A.H. van Leeuwen, Henk Everaars, Peter M. van de Ven, Stijn L. Brinckman, Jorik R. Timmer, Martijn Meuwissen, Joost C.M. Meijers, Arno P. van der Weerdt, Tim J.F. ten Cate, Jan J. Piek, Clemens von Birgelen, Roberto Diletti, Javier Escaned, Albert C. van Rossum, Robin Nijveldt, Niels van Royen*

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalInternational Journal of Cardiology
Volume336
DOIs
Publication statusPublished - 1 Aug 2021

Bibliographical note

Funding Information:
This work was supported by unrestricted research grants from AstraZeneca and Biotronik. The collaboration was financed by the Ministry of Economic Affairs, The Netherlands by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.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.

Funding Information:
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.

Funding Information:
This work was supported by unrestricted research grants from AstraZeneca and Biotronik . The collaboration was financed by the Ministry of Economic Affairs , The Netherlands by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.

Publisher Copyright:
© 2021 The Author(s)

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