Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography
BackgroundFew data are available regarding the optimal management of ST‐elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess w...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.004552 |
| _version_ | 1811329019533066240 |
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| author | Paul Fefer Roy Beigel Shaul Atar Doron Aronson Arthur Pollak Doron Zahger Elad Asher Zaza Iakobishvili Nir Shlomo Ronny Alcalai Michal Einhorn‐Cohen Amit Segev Ilan Goldenberg Shlomi Matetzky |
| author_facet | Paul Fefer Roy Beigel Shaul Atar Doron Aronson Arthur Pollak Doron Zahger Elad Asher Zaza Iakobishvili Nir Shlomo Ronny Alcalai Michal Einhorn‐Cohen Amit Segev Ilan Goldenberg Shlomi Matetzky |
| author_sort | Paul Fefer |
| collection | DOAJ |
| description | BackgroundFew data are available regarding the optimal management of ST‐elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess whether immediate reperfusion can be deferred. Methods and ResultsData were drawn from a prospective nationwide survey, ACSIS (Acute Coronary Syndrome Israeli Survey). Definition of SR was predefined as both (1) ≥70% reduction in ST‐segment elevation on consecutive ECGs and (2) ≥70% resolution of pain. Of 2361 consecutive ST‐elevation–acute coronary syndrome patients in Killip class 1, 405 (17%) were not treated with primary reperfusion therapy because of SR. Intervention in SR patients was performed a median of 26 hours after admission. These patients were compared with the 1956 ST‐elevation myocardial infarction patients who underwent primary reperfusion with a median door‐to‐balloon of 66 minutes (interquartile range 38–106). Baseline characteristics were similar except for slightly higher incidence of renal dysfunction and prior angina pectoris in SR patients. Time from symptom onset to medical contact was significantly greater in SR patients. Patients with SR had significantly less in‐hospital heart failure (4% versus 11%) and cardiogenic shock (0% versus 2%) (P<0.01 for all). No significant differences were found in in‐hospital mortality (1% versus 2%), 30‐day major cardiac events (4% versus 4%), and mortality at 30 days (1% versus 2%) and 1 year (4% versus 4%). ConclusionsPatients with clinically defined SR have a favorable prognosis. Deferring immediate intervention seems to be safe in patients with clinical indices of spontaneous reperfusion. |
| first_indexed | 2024-04-13T15:36:24Z |
| format | Article |
| id | doaj.art-386995d0d3e64b7c99ff8f4e4b7c8b22 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:36:24Z |
| publishDate | 2017-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-386995d0d3e64b7c99ff8f4e4b7c8b222022-12-22T02:41:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-07-016710.1161/JAHA.116.004552Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred AngiographyPaul Fefer0Roy Beigel1Shaul Atar2Doron Aronson3Arthur Pollak4Doron Zahger5Elad Asher6Zaza Iakobishvili7Nir Shlomo8Ronny Alcalai9Michal Einhorn‐Cohen10Amit Segev11Ilan Goldenberg12Shlomi Matetzky13Leviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelDivision of Cardiology, Galilee Medical Center, Nahariya, IsraelDepartment of Cardiology, Rambam Healthcare Campus and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelHeart Institute, Hadassah University Hospital, Jerusalem, IsraelDepartment of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelDepartment of Cardiology, Rabin Medical Center, Petah Tikva, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelHeart Institute, Hadassah University Hospital, Jerusalem, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelLeviev Heart Center, Sheba Medical Center, Tel Hashomer, IsraelBackgroundFew data are available regarding the optimal management of ST‐elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess whether immediate reperfusion can be deferred. Methods and ResultsData were drawn from a prospective nationwide survey, ACSIS (Acute Coronary Syndrome Israeli Survey). Definition of SR was predefined as both (1) ≥70% reduction in ST‐segment elevation on consecutive ECGs and (2) ≥70% resolution of pain. Of 2361 consecutive ST‐elevation–acute coronary syndrome patients in Killip class 1, 405 (17%) were not treated with primary reperfusion therapy because of SR. Intervention in SR patients was performed a median of 26 hours after admission. These patients were compared with the 1956 ST‐elevation myocardial infarction patients who underwent primary reperfusion with a median door‐to‐balloon of 66 minutes (interquartile range 38–106). Baseline characteristics were similar except for slightly higher incidence of renal dysfunction and prior angina pectoris in SR patients. Time from symptom onset to medical contact was significantly greater in SR patients. Patients with SR had significantly less in‐hospital heart failure (4% versus 11%) and cardiogenic shock (0% versus 2%) (P<0.01 for all). No significant differences were found in in‐hospital mortality (1% versus 2%), 30‐day major cardiac events (4% versus 4%), and mortality at 30 days (1% versus 2%) and 1 year (4% versus 4%). ConclusionsPatients with clinically defined SR have a favorable prognosis. Deferring immediate intervention seems to be safe in patients with clinical indices of spontaneous reperfusion.https://www.ahajournals.org/doi/10.1161/JAHA.116.004552outcomespontaneous reperfusionST‐elevation myocardial infarction |
| spellingShingle | Paul Fefer Roy Beigel Shaul Atar Doron Aronson Arthur Pollak Doron Zahger Elad Asher Zaza Iakobishvili Nir Shlomo Ronny Alcalai Michal Einhorn‐Cohen Amit Segev Ilan Goldenberg Shlomi Matetzky Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease outcome spontaneous reperfusion ST‐elevation myocardial infarction |
| title | Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography |
| title_full | Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography |
| title_fullStr | Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography |
| title_full_unstemmed | Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography |
| title_short | Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography |
| title_sort | outcomes of patients presenting with clinical indices of spontaneous reperfusion in st elevation acute coronary syndrome undergoing deferred angiography |
| topic | outcome spontaneous reperfusion ST‐elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.004552 |
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