title: Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial.
abstract: BACKGROUND
  We evaluated the prespecified endpoint, aborted myocardial infarction (AbMI), according to the use of a pharmacoinvasive (PI) strategy versus primary percutaneous coronary intervention (PCI) in 1754 patients randomised within 3 h of symptom onset in the STrategic Reperfusion Early After Myocardial infarction (STREAM) trial.
  
  
  METHODS
  Based on sequential ECG's and biomarkers, AbMI was defined as ST-elevation resolution ≥50% (90 min posttenecteplase (TNK) in the PI arm or 30 min postprimary PCI) with minimal biomarker rise.
  
  
  RESULTS
  In the PI arm 11.1% (n=99) had AbMI versus 6.9% (n=59) in primary PCI arm (p<0.01). In a multivariable model, AbMI patients overall had less baseline ΣST-deviation, fewer baseline Q-waves and shorter total ischaemic times. PI AbMI patients had faster time to TNK (90 vs 100 min, p=0.015): total ischaemic time was 100 min longer in primary PCI AbMI patients and no difference in ischaemic time existed between AbMI and non-AbMI patients within this group. Although no significant interaction between treatment and AbMI on the composite endpoint of death/shock/congestive heart failure/recurrent MI occurred (p=0.292), PI AbMI patients had a lower incidence in this endpoint than non-AbMI patients (5.1 vs 12%, p=0.038); this was not evident in primary PCI patients. Forty-five patients (ie, 2.5%) had masquerading MI with minimal biomarker elevation and no evolution in baseline ST-elevation.
  
  
  CONCLUSIONS
  A PI strategy of early fibrinolysis more frequently aborts MI than primary PCI. Such PI patients had more favourable outcomes as compared with non-AbMIs. Diligent review of ECG evolution in STEMI distinguishes AbMI from infarct masquerade. ClinicalTrials.gov ID: NCT00623623.
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
authors.forename: Neda
authors.initials: N
authors.lastname: Dianati Maleki
authors.affiliation: Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.affiliation: Emergency Department, Lille University Hospital France, Lille Cedex, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: The Heart Centre, Royal Victoria Hospital, Belfast, Ireland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Adgey
authors.affiliation: Hôpital André Mignot, Centre Hospier de Versailles, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lambert
authors.affiliation: Department of Internal Diseases, 1st Moscow State Medical University, Moscow, Russian Federation.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Sulimov
authors.affiliation: Empresa Publica de Emergencias Sanitarias, Almería, Spain.
authors.forename: Fernando
authors.identifier: http://orcid.org/0000-0003-0260-9955
authors.initials: F
authors.lastname: Rosell-Ortiz
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit, University Hospital of Leicester, Leicester, UK.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
authors.forename: Yinggan
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D052279:Creatine Kinase, MB Form / Q000097:blood*; D061345:Early Medical Intervention / Q000379:methods / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000592:standards; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D014336:Troponin; D052279:Creatine Kinase, MB Form
keywords: CARDIAC FUNCTION; INTERVENTIONAL CARDIOLOGY; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)