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J Am Coll Cardiol, 2004; 44:38-43, doi:10.1016/j.jacc.2004.03.041 © 2004 by the American College of Cardiology Foundation |
* 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.
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