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Lemkes JS, Janssens GN, van der Hoeven NW, et al. Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. Eur Heart J. 2019;40(3):283-291doi: 10.1093/eurheartj/ehy651.
Lemkes, J. S., Janssens, G. N., van der Hoeven, N. W., van de Ven, P. M., Marques, K. M. J., Nap, A., van Leeuwen, M. A. H., Appelman, Y. E. A., Knaapen, P., Verouden, N. J. W., Allaart, C. P., Brinckman, S. L., Saraber, C. E., Plomp, K. J., Timmer, J. R., Kedhi, E., Hermanides, R. S., Meuwissen, M., Schaap, J., van der Weerdt, A. P., van Rossum, A. C., Nijveldt, R., & van Royen, N. (2019). Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. European heart journal, 40(3), 283-291. https://doi.org/10.1093/eurheartj/ehy651
Lemkes, Jorrit S, et al. "Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial." European heart journal vol. 40,3 (2019): 283-291. doi: https://doi.org/10.1093/eurheartj/ehy651
Lemkes JS, Janssens GN, van der Hoeven NW, van de Ven PM, Marques KMJ, Nap A, van Leeuwen MAH, Appelman YEA, Knaapen P, Verouden NJW, Allaart CP, Brinckman SL, Saraber CE, Plomp KJ, Timmer JR, Kedhi E, Hermanides RS, Meuwissen M, Schaap J, van der Weerdt AP, van Rossum AC, Nijveldt R, van Royen N. Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. Eur Heart J. 2019 Jan 14;40(3):283-291. doi: 10.1093/eurheartj/ehy651. PMID: 30371767.
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Eur Heart J. 2019 Jan 14;40(3):283-291. doi: 10.1093/eurheartj/ehy651.

Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial.

European heart journal

Jorrit S Lemkes, Gladys N Janssens, Nina W van der Hoeven, Peter M van de Ven, Koen M J Marques, Alexander Nap, Maarten A H van Leeuwen, Yolande E A Appelman, Paul Knaapen, Niels J W Verouden, Cornelis P Allaart, Stijn L Brinckman, Colette E Saraber, Koos J Plomp, Jorik R Timmer, Elvin Kedhi, Renicus S Hermanides, Martijn Meuwissen, Jeroen Schaap, Arno P van der Weerdt, Albert C van Rossum, Robin Nijveldt, Niels van Royen

Affiliations

  1. Department of Cardiology, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
  2. Department of Epidemiology and Biostatistics, VU University, De Boelelaan 1089a, Amsterdam, the Netherlands.
  3. Department of Cardiology, Isala Heart Center, Dokter van Heesweg 2, Zwolle, the Netherlands.
  4. Department of Cardiology, Tergooi Hospital, Rijksstraatweg 1, Blaricum, the Netherlands.
  5. Department of Cardiology, Amphia Hospital, Molengracht 21, Breda, the Netherlands.
  6. Department of Cardiology, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, the Netherlands.
  7. Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.

PMID: 30371767 DOI: 10.1093/eurheartj/ehy651

Abstract

AIMS: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).

METHODS AND RESULTS: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography.

CONCLUSION: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.

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