CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION
Aborted myocardial infarction in patients with ST-segment elevation
Insights from the assessment of the safety and efficacy of a new thrombolytic regimen-3 trial electrocardiographic substudy
Taha Taher, MD*,
Yuling Fu, MD*,
Galen S. Wagner, MD ,
Shaun G. Goodman, MD ,
Claudio Fresco, MD ,
Christopher B. Granger, MD,
Lars Wallentin, MD||,
Frans Van de Werf, MD¶,
Freek Verheugt, MD|| and
Paul W. Armstrong, MD*,*
* University of Alberta, Edmonton, Alberta, Canada
Duke Clinical Research Institute, Durham, North Carolina, USA
Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Hospital S. Maria della Misericordi, Udine, Italy
|| University Hospital Gasthuisber, Leuven, Belgium
¶ University Medical Center St. Radboud, Nijmegen, The Netherlands
Manuscript received January 8, 2004;
revised manuscript received March 4, 2004,
accepted March 11, 2004.
* Reprint requests and correspondence: Dr. Paul W. Armstrong, University of Alberta, 2-51 Medical Sciences Building, Edmonton, Alberta T6G 2H7 Canada.
paul.Armstrong{at}ualberta.ca
OBJECTIVES: The investigators undertook a systematic, comprehensive analysis of the therapeutic response and clinical outcomes of reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in 5,470 patients from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 trial.
BACKGROUND: Prompt effective reperfusion therapy for acute STEMI may attenuate major myocardial necrosis.
METHODS: We prospectively collected sequential electrocardiographs and clinical data. Aborted myocardial infarction (MI) was defined as maximal creatine kinase  2x upper limit of normal coupled with typical evolutionary electrocardiographic changes.
RESULTS: Of the patients, 727 (13.3%) had an aborted MI, with the highest frequency (25%) occurring in patients treated <1 h after symptom onset. As compared with MI patients, patients with aborted MI more often had complete ST-segment resolution at 60 min (56.3% vs. 30.2%, p < 0.001) and 180 min (61.5% vs. 53%, p < 0.001); they also had smaller infarct sizes based on QRS score at discharge (2.37 vs. 4.62, p <0 .001). Mortality in aborted MI patients compared with those who had true MI was 3.9% versus 4.6% at 30-day and 7.0% versus 7.4% at 1-year. The baseline-adjusted mortality was significantly lower in patients with aborted MI (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.63 to 0.92, p = 0.005 for 30-day and OR 0.70, 95% CI 0.50 to 0.98, p = 0.035 for one year). A very low-risk subset was identified with  70% ST-segment resolution at 60 min whose 30-day and 1-year mortality was 1.0% and 2.7%, respectively, compared with 5.9% and 9.3% in aborted MI patients with <70% ST-segment resolution at 60 min (all p 0.002).
CONCLUSIONS: Prompt fibrinolytic treatment improved the likelihood of aborted MI. The subgroup with complete 60-min ST-segment resolution had the best clinical outcomes.
|
Abbreviations and Acronyms
| | ASSENT-3 | = Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 trial | | CABG | = coronary artery bypass graft | | CI | = confidence interval | | CK-MB | = creatine kinase-MB fraction | | ECG | = electrocardiogram/electrocardiographic | | MI | = myocardial infarction | | OR | = odds ratio | | PCI | = percutaneous coronary intervention | | STEMI | = ST-segment elevation myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
S N Khan, P Murray, L McCormick, L S Sharples, P Salahshouri, J Scott, and P M Schofield
Paramedic-led prehospital thrombolysis is safe and effective: the East Anglian experience
Emerg. Med. J.,
June 1, 2009;
26(6):
452 - 455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W. Armstrong, C. M. Westerhout, and R. C. Welsh
Duration of Symptoms Is the Key Modulator of the Choice of Reperfusion for ST-Elevation Myocardial Infarction
Circulation,
March 10, 2009;
119(9):
1293 - 1303.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Bogaty
Duration of Symptoms Is Not Always the Key Modulator of the Choice of Reperfusion for ST-Elevation Myocardial Infarction
Circulation,
March 10, 2009;
119(9):
1304 - 1310.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L Jackson, J Kendall, and N Castle
Does prehospital thrombolysis increase the proportion of patients who have an aborted myocardial infarction?
Emerg. Med. J.,
March 1, 2009;
26(3):
206 - 209.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. De Luca
Adjunctive antithrombotic therapy during primary percutaneous coronary intervention
Eur. Heart J. Suppl.,
December 1, 2008;
10(suppl_J):
J2 - J14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W Armstrong
Defining myocardial infarction: a work in progress
Heart,
August 1, 2008;
94(8):
1076 - 1079.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. McDonald, Y. Fu, U. Zeymer, G. Wagner, S. G. Goodman, A. Ross, C. B. Granger, F. Van de Werf, P. W. Armstrong, and for the ASSENT-4 PCI Investigators
Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy
Eur. Heart J.,
April 1, 2008;
29(7):
871 - 879.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Glover and A.A. J. Adgey
Acute reperfusion strategies for ST-segment elevation myocardial infarction
Eur. Heart J.,
March 1, 2008;
29(5):
571 - 572.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Kiernan, H. H. Ting, and B. J. Gersh
Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls
Eur. Heart J.,
July 1, 2007;
28(13):
1545 - 1553.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Fernandez-Aviles, J. J. Alonso, G. Pena, J. Blanco, J. Alonso-Briales, J. Lopez-Mesa, F. Fernandez-Vazquez, J. Moreu, R. A. Hernandez, A. Castro-Beiras, et al.
Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial
Eur. Heart J.,
April 2, 2007;
28(8):
949 - 960.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. Keeley and L. D. Hillis
Primary PCI for Myocardial Infarction with ST-Segment Elevation
N. Engl. J. Med.,
January 4, 2007;
356(1):
47 - 54.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Schomig, G. Ndrepepa, and A. Kastrati
Late myocardial salvage: time to recognize its reality in the reperfusion therapy of acute myocardial infarction
Eur. Heart J.,
August 2, 2006;
27(16):
1900 - 1907.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. W.A. Verheugt, B. J. Gersh, and P. W. Armstrong
Aborted myocardial infarction: a new target for reperfusion therapy
Eur. Heart J.,
April 2, 2006;
27(8):
901 - 904.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Gersh and E. M. Antman
Selection of the optimal reperfusion strategy for STEMI: does time matter?
Eur. Heart J.,
April 1, 2006;
27(7):
761 - 763.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R C Welsh and P W Armstrong
It's a matter of time: contemporary pre-hospital management of acute ST elevation myocardial infarction
Heart,
December 1, 2005;
91(12):
1524 - 1526.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines
The Case for Community Hospital Angioplasty
Circulation,
November 29, 2005;
112(22):
3509 - 3534.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R C Welsh, W Chang, P Goldstein, J Adgey, C B Granger, F W A Verheugt, L Wallentin, F Van de Werf, P W Armstrong, and on behalf of the ASSENT-3 PLUS Investigators
Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction: insights from the ASSENT-3 PLUS trial
Heart,
November 1, 2005;
91(11):
1400 - 1406.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G Tarantini, A Ramondo, and S Iliceto
Aborted myocardial infarction: a clinical-magnetic resonance correlation
Heart,
April 1, 2005;
91(4):
e24 - e24.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Gersh, G. W. Stone, H. D. White, and D. R. Holmes Jr
Pharmacological Facilitation of Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Is the Slope of the Curve the Shape of the Future?
JAMA,
February 23, 2005;
293(8):
979 - 986.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Rapid Fibrinolytic Therapy Can Abort MI
Journal Watch Emergency Medicine,
September 29, 2004;
2004(929):
3 - 3.
[Full Text]
|
|
|
|
