1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction

GN Janssens, NW van der Hoeven, JS Lemkes, H Everaars, PM van de Ven, KMJ Marques, A Nap, M.A.H. van Leeuwen, JEA Appelman, P Knaapen, CJW Verouden, CP Allaart, S. Brinckman, CE Saraber, K. Plomp, Jorik R Timmer, Elvin Kedhi, Renicus S Hermanides, Martijn Meuwissen, Jeroen Schaap & 4 others Arno P. Van Der Weerdt, AC van Rossum, R Nijveldt, N van Royen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives The aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year.

Background Up to 24% of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non–ST-segment elevation acute coronary syndrome–like intervention strategy.

Methods In this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months.

Results In the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4% [interquartile range: 0.0% to 2.5%] vs. 0.4% [interquartile range: 0.0% to 3.5%]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 ± 6.5% vs. 59.9 ± 5.4%; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7% vs. 4.4%, respectively; p = 1.00).

Conclusions At follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year.
Original languageEnglish
JournalJACC Cardiovascular Interventions
Publication statusPublished - 2 Sep 2019

Cite this

@article{f9c0a84df30243fa913981c36747a2b4,
title = "1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction",
abstract = "Objectives The aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year.Background Up to 24{\%} of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non–ST-segment elevation acute coronary syndrome–like intervention strategy.Methods In this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months.Results In the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4{\%} [interquartile range: 0.0{\%} to 2.5{\%}] vs. 0.4{\%} [interquartile range: 0.0{\%} to 3.5{\%}]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 ± 6.5{\%} vs. 59.9 ± 5.4{\%}; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7{\%} vs. 4.4{\%}, respectively; p = 1.00).Conclusions At follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year.",
keywords = "aborted STEMI, Coronary angiography, invasive strategy, Percutaneous coronary intervention, revascularization",
author = "GN Janssens and {van der Hoeven}, NW and JS Lemkes and H Everaars and {van de Ven}, PM and KMJ Marques and A Nap and {van Leeuwen}, M.A.H. and JEA Appelman and P Knaapen and CJW Verouden and CP Allaart and S. Brinckman and CE Saraber and K. Plomp and Timmer, {Jorik R} and Elvin Kedhi and Hermanides, {Renicus S} and Martijn Meuwissen and Jeroen Schaap and {Van Der Weerdt}, {Arno P.} and {van Rossum}, AC and R Nijveldt and {van Royen}, N",
year = "2019",
month = "9",
day = "2",
language = "English",
journal = "JACC Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",

}

1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction. / Janssens, GN; van der Hoeven, NW; Lemkes, JS; Everaars, H; van de Ven, PM; Marques, KMJ; Nap, A; van Leeuwen, M.A.H.; Appelman, JEA; Knaapen, P; Verouden, CJW; Allaart, CP; Brinckman, S.; Saraber, CE; Plomp, K.; Timmer, Jorik R; Kedhi, Elvin; Hermanides, Renicus S; Meuwissen, Martijn; Schaap, Jeroen; Van Der Weerdt, Arno P.; van Rossum, AC; Nijveldt, R; van Royen, N.

In: JACC Cardiovascular Interventions, 02.09.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - 1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction

AU - Janssens, GN

AU - van der Hoeven, NW

AU - Lemkes, JS

AU - Everaars, H

AU - van de Ven, PM

AU - Marques, KMJ

AU - Nap, A

AU - van Leeuwen, M.A.H.

AU - Appelman, JEA

AU - Knaapen, P

AU - Verouden, CJW

AU - Allaart, CP

AU - Brinckman, S.

AU - Saraber, CE

AU - Plomp, K.

AU - Timmer, Jorik R

AU - Kedhi, Elvin

AU - Hermanides, Renicus S

AU - Meuwissen, Martijn

AU - Schaap, Jeroen

AU - Van Der Weerdt, Arno P.

AU - van Rossum, AC

AU - Nijveldt, R

AU - van Royen, N

PY - 2019/9/2

Y1 - 2019/9/2

N2 - Objectives The aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year.Background Up to 24% of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non–ST-segment elevation acute coronary syndrome–like intervention strategy.Methods In this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months.Results In the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4% [interquartile range: 0.0% to 2.5%] vs. 0.4% [interquartile range: 0.0% to 3.5%]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 ± 6.5% vs. 59.9 ± 5.4%; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7% vs. 4.4%, respectively; p = 1.00).Conclusions At follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year.

AB - Objectives The aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year.Background Up to 24% of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non–ST-segment elevation acute coronary syndrome–like intervention strategy.Methods In this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months.Results In the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4% [interquartile range: 0.0% to 2.5%] vs. 0.4% [interquartile range: 0.0% to 3.5%]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 ± 6.5% vs. 59.9 ± 5.4%; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7% vs. 4.4%, respectively; p = 1.00).Conclusions At follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year.

KW - aborted STEMI

KW - Coronary angiography

KW - invasive strategy

KW - Percutaneous coronary intervention

KW - revascularization

M3 - Article

JO - JACC Cardiovascular Interventions

JF - JACC Cardiovascular Interventions

SN - 1936-8798

ER -