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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction

David Martí1, José Luís Mestre1, Luisa Salido1

  • 1Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.

American Heart Journal
|December 3, 2014
PubMed

Insights

Subtle ST-elevation myocardial infarction (STEMI) is common and often presents with acute total coronary occlusion. Prompt diagnosis and treatment are crucial, similar to marked STEMI, despite similar long-term outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • Borderline electrocardiograms in ST-segment elevation myocardial infarction (STEMI) management pose challenges.
  • These borderline cases are linked to delayed interventions and incorrect patient discharges.

Purpose of the Study:

  • To evaluate the angiographic features and patient outcomes in subtle ST-elevation (STE) myocardial infarction.
  • To compare outcomes between patients with subtle STE and those with more pronounced STE.

Main Methods:

  • Prospective inclusion of 504 patients with suspected STEMI undergoing primary percutaneous coronary intervention.
  • Subtle STE defined as maximal preinterventional STE of 0.1 to 1 mm.
  • Angiograms analyzed by blinded investigators.

Main Results:

  • 18.3% of patients had subtle STE, with 86% showing Thrombolysis In Myocardial Infarction (TIMI) flow grade 0/1.
  • Subtle STE patients had higher rates of multivessel disease (57% vs. 44%) and longer reperfusion delays.
  • Long-term death or reinfarction rates were similar (10.0% vs. 12.6%).

Conclusions:

  • Subtle STEMI is a frequent clinical finding, typically associated with acute total coronary occlusion.
  • Patients with subtle STEMI require prompt diagnosis and treatment comparable to marked STEMI.
  • Subtle STEMI did not correlate with improved outcomes in univariate or multivariate analyses.
Abstract

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