Acute myocardial infarction with spontaneous reperfusion: clinical characteristics and optimal timing for revascularization.
BACKGROUND
Spontaneous coronary reperfusion occurs in 7-27% of patients with ST elevation myocardial infarction, and is an independent predictor of myocardial salvage, percutaneous coronary intervention success, and improved outcome.


OBJECTIVE
To determine the optimal PCI time for patients admitted to the hospital due to STEMI with SCR.


METHODS
We performed a retrospective analysis of all patients admitted to the coronary care unit between July 2002 and November 2004 with a diagnosis of STEMI with SCR.


RESULTS
The study group comprised 86 patients. There was not a single reinfarction episode during an observation period of 6579 patient hours. Cardiac catheterization was executed early (< 24 hours from pain onset) in 26 patients and late (> 24 hours) in 55. Pre-PCI angiographic TIMI flow 2-3 was seen in > 95% in both groups. PCI was performed more frequently in the "early" group (P = 0.024), while multi-vessel coronary artery disease (P = 0.094) requiring coronary bypass surgery (P = 0.056) was observed more frequently in the "late catheterization" group. Myocardial infarction and angina pectoris at 30 days occurred more frequently in the early catheterization group (P = 0.039), however no difference in any major adverse cardiac events was detected during long-term follow-up (491 +/- 245 days).


CONCLUSIONS
Reinfarction after STEMI with SCR is a rare event. Early PCI in patients with STEMI and SCR, even when executed with aggressive antiplatelet therapy, seems to result in an excess of early MACE without any long-term advantage. Prospective randomized trials should determine the optimal PCI timing for these patients.
Uriel
Nir
N
Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel. urielnir@gmail.com
Moravsky
Gil
G
Blatt
Alex
A
Tourovski
Arkadi
A
Gabara
Ziad
Z
Inna
Yofik
Y
Danicek
Vladimir
V
Hendler
Alberto
A
Braunstein
Rony
R
Krakover
Ricardo
R
Vered
Zvi
Z
Kaluski
Edo
E
D017023:Coronary Angiography; D003657:Decision Making; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D009204:Myocardial Revascularization; D011379:Prognosis; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013997:Time Factors