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Original article
Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial
  1. Neda Dianati Maleki1,
  2. Frans Van de Werf2,
  3. Patrick Goldstein3,
  4. Jennifer A Adgey4,
  5. Yves Lambert5,
  6. Vitaly Sulimov6,
  7. Fernando Rosell-Ortiz7,
  8. Anthony H Gershlick8,
  9. Yinggan Zheng1,
  10. Cynthia M Westerhout1,
  11. Paul W Armstrong1
  1. 1Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
  2. 2Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
  3. 3Emergency Department, Lille University Hospital France, Lille Cedex, France
  4. 4The Heart Centre, Royal Victoria Hospital, Belfast, Ireland
  5. 5Hôpital André Mignot, Centre Hospier de Versailles, Paris, France
  6. 6Department of Internal Diseases, 1st Moscow State Medical University, Moscow, Russian Federation
  7. 7Empresa Publica de Emergencias Sanitarias, Almería, Spain
  8. 8Leicester Cardiovascular Biomedical Research Unit, University Hospital of Leicester, Leicester, UK
  1. Correspondence to Dr Paul W Armstrong, Canadian VIGOUR Centre, University of Alberta, 2–132 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada T6G 2E1; paul.armstrong{at}ualberta.ca

Abstract

Background We evaluated the prespecified endpoint, aborted myocardial infarction (AbMI), according to the use of a pharmacoinvasive (PI) strategy versus primary percutaneous coronary intervention (PCI) in 1754 patients randomised within 3 h of symptom onset in the STrategic Reperfusion Early After Myocardial infarction (STREAM) trial.

Methods Based on sequential ECG's and biomarkers, AbMI was defined as ST-elevation resolution ≥50% (90 min posttenecteplase (TNK) in the PI arm or 30 min postprimary PCI) with minimal biomarker rise.

Results In the PI arm 11.1% (n=99) had AbMI versus 6.9% (n=59) in primary PCI arm (p<0.01). In a multivariable model, AbMI patients overall had less baseline ΣST-deviation, fewer baseline Q-waves and shorter total ischaemic times. PI AbMI patients had faster time to TNK (90 vs 100 min, p=0.015): total ischaemic time was 100 min longer in primary PCI AbMI patients and no difference in ischaemic time existed between AbMI and non-AbMI patients within this group. Although no significant interaction between treatment and AbMI on the composite endpoint of death/shock/congestive heart failure/recurrent MI occurred (p=0.292), PI AbMI patients had a lower incidence in this endpoint than non-AbMI patients (5.1 vs 12%, p=0.038); this was not evident in primary PCI patients. Forty-five patients (ie, 2.5%) had masquerading MI with minimal biomarker elevation and no evolution in baseline ST-elevation.

Conclusions A PI strategy of early fibrinolysis more frequently aborts MI than primary PCI. Such PI patients had more favourable outcomes as compared with non-AbMIs. Diligent review of ECG evolution in STEMI distinguishes AbMI from infarct masquerade.

Clinical Trials.gov ID NCT00623623.

  • CARDIAC FUNCTION
  • INTERVENTIONAL CARDIOLOGY
  • MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)

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