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Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial.

Publication ,  Journal Article
Dianati Maleki, N; Van de Werf, F; Goldstein, P; Adgey, JA; Lambert, Y; Sulimov, V; Rosell-Ortiz, F; Gershlick, AH; Zheng, Y; Westerhout, CM ...
Published in: Heart
October 2014

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. ClinicalTrials.gov ID: NCT00623623.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

October 2014

Volume

100

Issue

19

Start / End Page

1543 / 1549

Location

England

Related Subject Headings

  • Troponin
  • Treatment Outcome
  • Time-to-Treatment
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents
  • Female
 

Citation

APA
Chicago
ICMJE
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Dianati Maleki, N., Van de Werf, F., Goldstein, P., Adgey, J. A., Lambert, Y., Sulimov, V., … Armstrong, P. W. (2014). Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial. Heart, 100(19), 1543–1549. https://doi.org/10.1136/heartjnl-2014-306023
Dianati Maleki, Neda, Frans Van de Werf, Patrick Goldstein, Jennifer A. Adgey, Yves Lambert, Vitaly Sulimov, Fernando Rosell-Ortiz, et al. “Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial.Heart 100, no. 19 (October 2014): 1543–49. https://doi.org/10.1136/heartjnl-2014-306023.
Dianati Maleki N, Van de Werf F, Goldstein P, Adgey JA, Lambert Y, Sulimov V, et al. Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial. Heart. 2014 Oct;100(19):1543–9.
Dianati Maleki, Neda, et al. “Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial.Heart, vol. 100, no. 19, Oct. 2014, pp. 1543–49. Pubmed, doi:10.1136/heartjnl-2014-306023.
Dianati Maleki N, Van de Werf F, Goldstein P, Adgey JA, Lambert Y, Sulimov V, Rosell-Ortiz F, Gershlick AH, Zheng Y, Westerhout CM, Armstrong PW. Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial. Heart. 2014 Oct;100(19):1543–1549.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

October 2014

Volume

100

Issue

19

Start / End Page

1543 / 1549

Location

England

Related Subject Headings

  • Troponin
  • Treatment Outcome
  • Time-to-Treatment
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents
  • Female