Characteristics of Transient ST-Elevation versus ST-Elevation and Non-ST-Elevation Myocardial Infarction

Transcription

1 Characteristics of Transient ST-Elevation versus ST-Elevation and Non-ST-Elevation Myocardial Infarction Blondheim DS, Shochat M, Asif A, Kazatsker M, Frimerman A, Vassilenko L, Abu Fane R, Neiman E, Barel M, Levy Y, Shotan A, Meisel SR Department of Cardiology Hillel Yaffe Medical Center Hadera, Israel

2 Disclosure of interests We, DS Blondheim, SR Meisel, and all other authors do not have any financial interest, arrangement or affiliation with any organizations that could be perceived as a real or apparent conflict of interests in the context of the subject of this presentation.

3 Characteristics of Transient ST-Elevation versus ST-Elevation and Non-ST-Elevation Myocardial Infarction Blondheim DS, Shochat M, Asif A, Kazatsker M, Frimerman A, Vassilenko L, Abu Fane R, Neiman E, Barel M, Levy Y, Shotan A, Meisel SR Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel Introduction Transient-ST-elevation-myocardial infarction (TSTEMI) is usually grouped together with ST-elevation MI (STEMI) or with non-stelevation MI (NSTEMI). However, we have previously shown it to be substantially different from STEMI. In the current study we describe its characteristics and compare it to large cohorts of both STEMI and NSTEMI patients. Methods All AMI patients (typical chest pain + elevated CPK and Troponin-T levels) admitted to the CCU, were grouped according to their ECG features: STEMI GROUP- Sustained ST-elevation on pre-admission and on CCU admission ECG. NSTEMI GROUP- ST-depression and/or T-wave inversion on pre-admission and on CCU admission ECG. TSTEMI GROUP- ST-elevation in at least one pre-admission ECG which completely normalized on admission ECG. Patient characteristics, risk factors, lab results, clinical features including time intervals, therapy received and outcome were analyzed within groups and compared between groups. Patients were followed up at least a year after discharge.

4 Results Baseline and admission characteristics, extent of CAD, myocardial damage and outcome by study group Patient Characteristics Age (yrs) Males (%) Hypertension (%) Diabetes Type 2 (%) Hyperlipidemia (%) Smokers (%) History of MI (%) Risk factors per patient Admission Data Pulse rate (bpm) Systolic BP (mmhg) Creatinine (mg%) Glucose (mg%) Initial CPK (mg%) Initial Troponin (ng/ml) Extent of CAD Diseased vessels LAD (%) Stents >1 (%) LV Damage Peak CPK (mg%) LVEF (%) Outcome ICU stay (days) Hospital stay (days) Mortality (In-hospital) (%) Mortality (Total) (%) TSTEMI N= ±9.6 (56) 88.1 # 52.3 # 26.4 # 64.0 # 77.8 $ 22.2 # 2.2±1.0 (2) # NSTEMI N= (62) ^ 77.2^ 74.2^ 47.8^ 77.3^ 53.9^ 42.2^ 2.5±1.0 (3) ^ STEMI N= ±12.5 (58) ±1.1 (2) P< TSTEMI risk factor profile similar to STEMI profile. 75.2±15.1 (76) 141±30 (138) # 0.9±0.2 (0.9) # 151±72 (124)* 173±194 (115)* 70±240 (20)* 84.1±23.1 (80) 149±29 (147) ^ 1.1±0.8 (1.0) ^ 176±95 (142) 276±476 (148) 60±100 (30) ^ 81.3±22.8 (80) 138±31 (138) 1.1±0.7 (1.0) 181±99 (145) 340±772 (159) 180±340 (50) NS Admission data of STEMI group are "better" than both NSTEMI and STEMI groups #$ 78 $ ^ Extent of CAD in TSTEMI is similar to NSTEMI and STEMI but LAD disease is less prevalent. 480±572 (249)* 61±8 (65)* 549±720 (330) 55±13 (65) ±2092 (1019) 49±13 (48) TSTEMI group had less myocardial damage than NSTEMI and STEMI groups. 2.9±1.2 (3) * 3.4±1.5 (3) * $ 0.0* 4.8* $ 2.8±1.9 (3) ^ 5.5±3.7 (4) 2.3^ ±2.3 (3) 5.2±3.9 (4) Outcome of TSTEMI group was better compared to both NSTEMI and STEMI groups. Data are presented as mean ± SD (median), unless stated otherwise. * TSTEMI vs. STEMI, $ TSTEMI vs. NSTEMI, ^ NSTEMI vs. STEMI NS

5 Kaplan-Meier survival curves of the 3 study groups Patient management was similar to NSTEMI (more thrombolysis and less PPCI than STEMI) but outcome was significantly better compared to both STEMI and, surprisingly, NSTEMI.

6 Conclusions 1. Despite similar risk factors and extent of CAD, TSTEMI patients had a more benign in-hospital course, less myocardial damage and better outcome than both STEMI and NSTEMI patients. 2. Therapy administered to TSTEMI patients was similar to that of NSTEMI group (more thrombolysis and late PCI than STEMI group) but survival was better than that of NSTEMI which was almost identical to the STEMI group. 3. The data support the notion that TSTEMI is an aborted STEMI and has a benign outcome. Current guidelines should recognize TSTEMI as a separate subgroup of MI, that if treated properly, has an excellent outcome. Address: davidb@hy.health.gov.il