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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Aborted myocardial infarction in patients with ST-segment elevation myocardial infarction treated with mechanical
Insights
Aborted myocardial infarction (abMI) patients treated with primary percutaneous coronary intervention (pPCI) show better outcomes. This study defines abMI and identifies characteristics of these patients, including younger age and higher ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Aborted myocardial infarction (abMI) is a subset of acute coronary syndrome where necrosis is avoided post-reperfusion.
- No standardized definition for abMI in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) exists.
Purpose of the Study:
- To establish a definition for abMI in STEMI patients treated with pPCI.
- To compare the clinical characteristics and outcomes of abMI patients with other STEMI patients.
Main Methods:
- Retrospective analysis of 1693 STEMI patients treated with pPCI.
- AbMI definition criteria: >50% ST-segment elevation reduction, no new Q waves, peak CK-MB <5x upper limit of normal, and Thrombolysis in Myocardial Infarction (TIMI) score of 3 post-PCI.
- Median follow-up of 3.45 years.
Main Results:
- AbMI identified in 10.4% of patients (176 cases).
- AbMI patients were younger, more frequent smokers, had higher left ventricular ejection fraction, shorter hospitalization, and significantly lower 1-month and long-term mortality.
- Key differences observed: age (61.8 vs 64.4 years), smoking (48.9% vs 36.7%), LVEF (49% vs 55%), hospitalization (73 vs 87 hours), mortality (2.27% vs 8% at 1 month; 10.8% vs 23.9% long-term).
Conclusions:
- A clear definition for abMI in pPCI-treated STEMI patients was established.
- Patients with abMI demonstrate superior short- and long-term clinical outcomes compared to other STEMI patients.
- Despite presenting with risk factors like smoking, abMI patients experience better prognoses, highlighting the effectiveness of timely reperfusion therapy.
Background:
Aborted myocardial infarction (abMI) is a type of acute coronary syndrome in which patients treated with reperfusion avoid the great burden of necrosis. Yet, no definition of abMI in patients undergoing primary percutaneous coronary intervention (pPCI) has been proposed so far.
Aims:
This study aimed to identify patients with abMI and compare them with the remaining patients with ST‑segment elevation myocardial infarction (STEMI).
Methods:
It was a retrospective study of 1693 consecutive patients with STEMI treated with pPCI. The median (IQR) follow‑up was 3.45 (1.45-5.09) years. Aborted MI was diagnosed if ST‑segment elevation was reduced by more than 50%, no new abnormal Q waves were observed, the maximal level of creatine kinase MB did not reach a value 5‑fold higher than the upper limit of normal (below 125 U/l), and there was successful reperfusion defined as the Thrombolysis in Myocardial Infarction score of 3 after PCI.
Results:
Using our definition, abMI was diagnosed in 176 cases (10.4%). Compared with the remaining patients with STEMI, those with abMI were younger (mean [SD] age, 61.8 [11.5] vs 64.4 [11.6] years; P = 0.005) and were more frequent smokers (48.9% vs 36.7%; P = 0.002). They had greater left ventricular ejection fraction (median [interquartile range (IQR)], 49% [40%-55%] vs 55% [51%-60.5%]; P <0.001), were discharged earlier from the hospital (hospitalization time, median [IQR], 73 [60-90.5] hours vs 87 [69-98] hours; P <0.001), and had a lower mortality rate at 1 month and long‑term follow‑up (2.27% vs 8%; P = 0.006 and 10.8% vs 23.9%; P <0.001, respectively).
Conclusion:
Patients with abMI had better short‑ and long‑term outcomes than other patients with STEMI. Some negative cardiovascular factors such as smoking were more often observed in the abMI group.
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