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Aborted myocardial infarction in patients with ST-segment elevation

2004; Elsevier BV; Volume: 44; Issue: 1 Linguagem: Inglês

10.1016/j.jacc.2004.03.041

1558-3597

Taha Taher, Yuling Fu, Galen S. Wagner, Shaun G. Goodman, Claudio Fresco, Christopher B. Granger, Lars Wallentin, Frans Van de Werf, Freek W.A. Verheugt, Paul W. Armstrong,

Mechanical Circulatory Support Devices

The investigators undertook a systematic, comprehensive analysis of the therapeutic response and clinical outcomes of reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in 5,470 patients from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 trial.Prompt effective reperfusion therapy for acute STEMI may attenuate major myocardial necrosis.We prospectively collected sequential electrocardiographs and clinical data. Aborted myocardial infarction (MI) was defined as maximal creatine kinase < or =2x upper limit of normal coupled with typical evolutionary electrocardiographic changes.Of the patients, 727 (13.3%) had an aborted MI, with the highest frequency (25%) occurring in patients treated <1 h after symptom onset. As compared with MI patients, patients with aborted MI more often had complete ST-segment resolution at 60 min (56.3% vs. 30.2%, p < 0.001) and 180 min (61.5% vs. 53%, p < 0.001); they also had smaller infarct sizes based on QRS score at discharge (2.37 vs. 4.62, p or =70% ST-segment resolution at 60 min whose 30-day and 1-year mortality was 1.0% and 2.7%, respectively, compared with 5.9% and 9.3% in aborted MI patients with <70% ST-segment resolution at 60 min (all p < or = 0.002).Prompt fibrinolytic treatment improved the likelihood of aborted MI. The subgroup with complete 60-min ST-segment resolution had the best clinical outcomes.