Transient ST-elevation myocardial infarction versus persistent ST-elevation myocardial infarction. An appraisal of
Gladys N Janssens1, Jorrit S Lemkes1, Nina W van der Hoeven1
1Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
Insights
Transient ST-elevation myocardial infarction (STEMI) shows less thrombus and spontaneous reperfusion, leading to reduced heart injury compared to persistent STEMI. Enhanced fibrinolysis may explain these better outcomes in transient STEMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Biomedical Science
Background:
- Up to 24% of ST-elevation myocardial infarction (STEMI) patients experience spontaneous ST-elevation resolution before revascularization.
- The mechanisms behind spontaneous reperfusion in STEMI are not fully understood.
- Transient STEMI is associated with more favorable outcomes, necessitating further investigation into its differential aspects.
Purpose of the Study:
- To compare clinical, angiographic, and laboratory characteristics of patients with transient STEMI versus persistent STEMI.
- To investigate the extent of myocardial injury and infarct size using cardiac magnetic resonance imaging (CMR).
- To explore differences in hemostatic parameters and fibrinolytic activity between the two groups.
Main Methods:
- A comparative study of 251 patients: 141 with transient STEMI and 110 with persistent STEMI.
- Collection of clinical, angiographic, and laboratory data, including hemostatic markers and CMR for myocardial injury assessment.
- Analysis of data at admission, follow-up, and steady-state to evaluate differences in thrombus burden, microvascular obstruction, infarct size, and fibrinolysis.
Main Results:
- Transient STEMI patients had more cardiovascular risk factors but less intracoronary thrombus and lower thrombus burden angiographically.
- CMR showed significantly less microvascular obstruction and smaller infarct size in transient STEMI patients.
- Higher fibrinolytic activity, indicated by reduced clot lysis time, was observed in transient STEMI patients.
Conclusions:
- Transient STEMI is characterized by reduced angiographic thrombus burden and spontaneous reperfusion, resulting in less myocardial injury.
- More effective fibrinolysis in transient STEMI patients may underlie these observed differences.
- Findings suggest potential therapeutic targets for improving STEMI treatment by leveraging insights from transient STEMI mechanisms.
Background:
Up to 24% of patients presenting with ST-elevation myocardial infarction (STEMI) show resolution of ST-elevation and symptoms before revascularization. The mechanisms of spontaneous reperfusion are unclear. Given the more favorable outcome of transient STEMI, it is important to obtain further insights in differential aspects.
Methods:
We compared 251 patients who presented with transient STEMI (n = 141) or persistent STEMI (n = 110). Clinical angiographic and laboratory data were collected at admission and in subset of patients additional index hemostatic data and at steady-state follow-up. Cardiac magnetic resonance imaging (CMR) was performed at 2-8 days to assess myocardial injury.
Results:
Transient STEMI patients had more cardiovascular risk factors than STEMI patients, including more arterial disease and higher cholesterol values. Transient STEMI patients showed angiographically more often no intracoronary thrombus (41.1% vs. 2.7%, P < 0.001) and less often a high thrombus burden (9.2% vs. 40.0%, P < 0.001). CMR revealed microvascular obstruction less frequently (4.2% vs. 34.6%, P < 0.001) and smaller infarct size [1.4%; interquartile range (IQR), 0.0-3.7% vs. 8.8%; IQR, 3.9-17.1% of the left ventricle, P < 0.001] with a better preserved left ventricular ejection fraction (57.8 ± 6.7% vs. 52.5 ± 7.6%, P < 0.001). At steady state, fibrinolysis was higher in transient STEMI, as demonstrated with a reduced clot lysis time (89 ± 20% vs. 99 ± 25%, P = 0.03).
Conclusions:
Transient STEMI is a syndrome with less angiographic thrombus burden and spontaneous infarct artery reperfusion, resulting in less myocardial injury than STEMI. The presence of a more effective fibrinolysis in transient STEMI patients may explain these differences and might provide clues for future treatment of STEMI.
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