Occurrence of Transient Myocardial Ischemic Events Among Non-ST Segment Elevation Acute Coronary Syndrome Patients
Sukardi Suba1, Mary G Carey1, Michele M Pelter2
1From the School of Nursing, University of Rochester, Rochester, NY.
Insights
Transient myocardial ischemia (TMI) in non-ST elevation acute coronary syndrome (NSTE-ACS) patients often occurs before invasive coronary angiography (ICA). TMI after ICA indicates a higher ischemic burden, warranting further investigation.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Transient myocardial ischemia (TMI) is a significant concern in non-ST elevation acute coronary syndrome (NSTE-ACS).
- Limited research exists on the timing of TMI during hospitalization relative to invasive coronary angiography (ICA).
Purpose of the Study:
- To determine the occurrence of TMI before or after ICA in NSTE-ACS patients.
- To analyze patient characteristics and ischemic burden based on TMI timing.
- To evaluate in-hospital complications and length of stay associated with TMI timing.
Main Methods:
- Secondary data analysis of hospitalized NSTE-ACS patients with TMI events detected via Holter monitoring.
- Assessment of ischemic burden using TMI duration relative to recording time.
- Review of patient records for TMI timing (pre- or post-ICA), outcomes, and complications.
Main Results:
- Nearly half of NSTE-ACS patients experienced TMI before ICA; a third underwent TMI without ICA.
- Patients with TMI after ICA demonstrated a significantly higher ischemic burden (7.29 min/h) compared to those with TMI before ICA (2.54 min/h).
- No significant differences were observed in patient characteristics or major adverse outcomes between groups.
Conclusions:
- TMI is common in NSTE-ACS patients, frequently occurring before ICA.
- A higher ischemic burden is associated with TMI occurring after ICA.
- Larger studies are necessary to elucidate the clinical implications of TMI timing in NSTE-ACS.
Background:
The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay by TMI group (before or after ICA).
Methods:
Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic Holter. Patient records were reviewed to assess ischemic burden [TMI time (min) ÷ hours recording duration], outcomes, and TMI timing, before or after ICA.
Results:
In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29 ± 8.82 min/h) compared to before ICA (2.54 ± 2.11 min/h), P = 0.039. Hospital length of stay by TMI group was 113 ± 113 (before), 226 ± 244 (after), and 85 ± 65 hours (no ICA); P = 0.172.
Conclusions:
Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had a higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.
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