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

Gladys N. Janssens; Nina W. van der Hoeven; Jorrit S. Lemkes; Henk Everaars; Peter M. van de Ven; Koen M.J. Marques; Alexander Nap; Maarten A.H. van Leeuwen; Yolande 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; Albert C. van Rossum; Robin Nijveldt; Niels van Royen

doi:10.1016/j.jcin.2019.07.018

JACC: Cardiovascular Interventions

Volume 12, Issue 22, November 2019 DOI: 10.1016/j.jcin.2019.07.018

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

Gladys N. Janssens, Nina W. van der Hoeven, Jorrit S. Lemkes, Henk Everaars, Peter M. van de Ven, Koen M.J. Marques, Alexander Nap, Maarten A.H. van Leeuwen, Yolande 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, Albert C. van Rossum, Robin Nijveldt and Niels van Royen

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Author + information

vol. 12 no. 22 2272-2282

DOI:

https://doi.org/10.1016/j.jcin.2019.07.018

Published By:

JACC: Cardiovascular Interventions

Print ISSN:

1936-8798

Online ISSN:

1876-7605

History:

Received April 26, 2019
Revision received July 2, 2019
Accepted July 16, 2019
Published online November 18, 2019.

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2019 American College of Cardiology Foundation

Author Information

Gladys N. Janssens, MD^a,
Nina W. van der Hoeven, MD^a,
Jorrit S. Lemkes, MD^a,
Henk Everaars, MD^a,
Peter M. van de Ven, PhD^b,
Koen M.J. Marques, MD, PhD^a,
Alexander Nap, MD, PhD^a,
Maarten A.H. van Leeuwen, MD, PhD^c,
Yolande Appelman, MD, PhD^a,
Paul Knaapen, MD, PhD^a,
Niels J.W. Verouden, MD, PhD^a,
Cornelis P. Allaart, MD, PhD^a,
Stijn L. Brinckman, MD^d,
Colette E. Saraber, MD^d,
Koos J. Plomp, MD^d,
Jorik R. Timmer, MD, PhD^c,
Elvin Kedhi, MD, PhD^c,
Renicus S. Hermanides, MD^c,
Martijn Meuwissen, MD^e,
Jeroen Schaap, MD^e,
Arno P. van der Weerdt, MD^f,
Albert C. van Rossum, MD, PhD^a,
Robin Nijveldt, MD, PhD^a,^g and
Niels van Royen, MD, PhD^a,^g,^∗ (niels.vanroyen{at}radboudumc.nl)

^aDepartment of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
^bDepartment of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
^cDepartment of Cardiology, Isala Heart Center, Zwolle, the Netherlands
^dDepartment of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
^eDepartment of Cardiology, Amphia Hospital, Breda, the Netherlands
^fDepartment of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
^gDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands

↵∗Address for correspondence:
Prof. Dr. Niels van Royen, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.

Central Illustration

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.

Key Words

Footnotes

This work was supported by unrestricted research grants from AstraZeneca and Biotronik. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Received April 26, 2019.
Revision received July 2, 2019.
Accepted July 16, 2019.

2019 American College of Cardiology Foundation

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