title: Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction.
abstract: BACKGROUND
  Borderline electrocardiograms represent a challenge in ST-segment elevation myocardial infarction (STEMI) management and are associated with inappropriate discharges and delays to intervention.
  
  
  OBJECTIVE
  To assess angiographic characteristics and outcomes of patients presenting with subtle ST-elevation (STE) myocardial infarction.
  
  
  METHODS
  A total of 504 consecutive patients with suspected STEMI treated by systematic primary percutaneous coronary intervention were prospectively included. Subtle STE was defined as a maximal preinterventional STE of 0.1 to 1 mm. Angiograms were interpreted by investigators unaware of the electrocardiographic data.
  
  
  RESULTS
  The proportion of patients with subtle STE was 18.3%, 86% of them presented with Thrombolysis In Myocardial Infarction flow grade 0/1 and 91% underwent percutaneous coronary intervention. Despite having smaller infarcts, subtle STE patients associated more frequent multivessel disease (57% vs 44%, P = .02) and larger delays to reperfusion. During a follow-up of 19.0 ± 4.9 months, the rates of death or reinfarction were similar among groups (10.0% vs 12.6%, P = .467). Subtle STE was not associated with better outcomes neither in univariate nor after adjustment in a multivariate analysis (adjusted hazard ratio 0.79, 95% CI 0.37-1.69, P = .546).
  
  
  CONCLUSIONS
  Subtle STEMI is frequent in clinical practice and is usually associated with acute total coronary occlusion. Therefore, it should be diagnosed and treated in the same expeditiously manner as marked STEMI.
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain. Electronic address: docalcala@hotmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Mestre
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Luisa
authors.initials: L
authors.lastname: Salido
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Esteban
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casas
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Pey
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanmartín
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D019468:Disease Management; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data