Clinical InvestigationAcute Ischemic Heart DiseaseIncidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction
Section snippets
Study patients
We conducted a prospective registry of all STE myocardial infarction (STEMI) patients presenting to a tertiary care center with a 24/7 pPCI program between June 2008 and October 2011. During the study period, 504 patients with persistent ischemic symptoms not responding to nitrates plus any STE were admitted for emergent coronary angiography. Patients with cardiogenic shock and out-of-hospital cardiac arrest were also included.
Twenty-four patients were excluded from analysis because the final
Electrocardiographic analysis and clinical presentation
Subtle STE was present in 88 (18.7%) patients with suspected STEMI and in 82 (18.3%) patients with confirmed STEMI (Figure 2).
Two-thirds of subtle STE infarctions involved the inferior wall (Table I). There were 10 “true posterior” (inferobasal) and 4 hyperacute anterior infarctions in this group. No patient presented with isolated STE in aVR. Reciprocal changes were common among subtle STE patients; 28 (37%) had ST-segment depression of 0.5 to 0.9 mm, and 23 (31%) of ≥1.0 mm.
Multivessel
Discussion
In this contemporary, real-world study of consecutive STEMI patients undergoing reperfusion, we find that (1) subtle STE myocardial infarction (STEMI) is frequent, comprising 18% of current STEMI; (2) most of these patients present with an acute coronary occlusion (TFG 0/1) and merit subsequent PCI; and (3) many of them have extensive coronary disease and similar clinical outcomes compared with those with more obvious ST changes.
Because of its inherent risks, initial thrombolytic trials
Conclusions
Almost 1 in 5 STEMI patients presents with subtle STE, which is usually associated with acute total coronary occlusion. These patients have extensive disease and experience larger delays to reperfusion. Improvements in early recognition are of paramount importance to provide adequate treatment.
Disclosures
Relative to this investigation, there are no relationships with industry or any potential conflict of interests to disclose.
Acknowledgements
We are very grateful to Nieves Plana and the Clinical Biostatistics Unit of Ramón y Cajal Hospital.
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Present address: Interventional Cardiology Unit, Department of Cardiology, Defense Central Hospital Gómez Ulla, University of Alcalá, Madrid, Spain.