Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial

Jorrit S Lemkes, Gladys N Janssens, Nina W van der Hoeven, Peter M van de Ven, Koen M J Marques, Alexander Nap, Maarten A H van Leeuwen, Yolande E A Appelman, Paul Knaapen, Niels J W Verouden, Cornelis P Allaart, Stijn L Brinckman, Colette E Saraber, Koos J Plomp, Jorik R Timmer, Elvin Kedhi, Renicus S Hermanides, Martijn Meuwissen, Jeroen Schaap, Arno P van der Weerdt & 3 others Albert C van Rossum, Robin Nijveldt, Niels van Royen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).

Methods and results: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography.

Conclusion: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.

Original languageEnglish
Pages (from-to)283-291
Number of pages9
JournalEuropean Heart Journal
Volume40
Issue number3
DOIs
Publication statusPublished - 26 Oct 2018

Cite this

@article{cdbf608503bc43d2b8495880b9a29279,
title = "Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial",
abstract = "Aims: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).Methods and results: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3{\%}; IQR 0.0-3.5{\%} vs. 1.5{\%} IQR 0.0-4.1{\%}, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9{\%} vs. 2.8{\%}, P = 1.00). However, four additional patients (5.6{\%}) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography.Conclusion: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.",
author = "Lemkes, {Jorrit S} and Janssens, {Gladys N} and {van der Hoeven}, {Nina W} and {van de Ven}, {Peter M} and Marques, {Koen M J} and Alexander Nap and {van Leeuwen}, {Maarten A H} and Appelman, {Yolande E A} and Paul Knaapen and Verouden, {Niels J W} and Allaart, {Cornelis P} and Brinckman, {Stijn L} and Saraber, {Colette E} and Plomp, {Koos J} 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}, {Albert C} and Robin Nijveldt and {van Royen}, Niels",
year = "2018",
month = "10",
day = "26",
doi = "10.1093/eurheartj/ehy651",
language = "English",
volume = "40",
pages = "283--291",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "3",

}

Timing of revascularization in patients with transient ST-segment elevation myocardial infarction : a randomized clinical trial. / Lemkes, Jorrit S; Janssens, Gladys N; van der Hoeven, Nina W; van de Ven, Peter M; Marques, Koen M J; Nap, Alexander; van Leeuwen, Maarten A H; Appelman, Yolande E A; Knaapen, Paul; Verouden, Niels J W; Allaart, Cornelis P; Brinckman, Stijn L; Saraber, Colette E; Plomp, Koos J; Timmer, Jorik R; Kedhi, Elvin; Hermanides, Renicus S; Meuwissen, Martijn; Schaap, Jeroen; van der Weerdt, Arno P; van Rossum, Albert C; Nijveldt, Robin; van Royen, Niels.

In: European Heart Journal, Vol. 40, No. 3, 26.10.2018, p. 283-291.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Timing of revascularization in patients with transient ST-segment elevation myocardial infarction

T2 - a randomized clinical trial

AU - Lemkes, Jorrit S

AU - Janssens, Gladys N

AU - van der Hoeven, Nina W

AU - van de Ven, Peter M

AU - Marques, Koen M J

AU - Nap, Alexander

AU - van Leeuwen, Maarten A H

AU - Appelman, Yolande E A

AU - Knaapen, Paul

AU - Verouden, Niels J W

AU - Allaart, Cornelis P

AU - Brinckman, Stijn L

AU - Saraber, Colette E

AU - Plomp, Koos J

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, Albert C

AU - Nijveldt, Robin

AU - van Royen, Niels

PY - 2018/10/26

Y1 - 2018/10/26

N2 - Aims: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).Methods and results: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography.Conclusion: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.

AB - Aims: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).Methods and results: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography.Conclusion: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups.

U2 - 10.1093/eurheartj/ehy651

DO - 10.1093/eurheartj/ehy651

M3 - Article

VL - 40

SP - 283

EP - 291

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 3

ER -