• Gladys N Janssens, Nina W van der Hoeven, Jorrit S Lemkes, Henk Everaars, Peter M van de Ven, MarquesKoen M JKMJDepartment of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Alexander Nap, van LeeuwenMaarten A HMAHDepartment of Cardiology, Isala Heart Center, Zwolle, the Netherlands., Yolande Appelman, Paul Knaapen, VeroudenNiels J WNJWDepartment of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Cornelis P Allaart, Stijn L Brinckman, Colette E Saraber, Koos J Plomp, Jorik R Timmer, Elvin Kedhi, Renicus S Hermanides, Martijn Meuwissen, Jeroen Schaap, Arno P van der Weerdt, Albert C van Rossum, Robin Nijveldt, and Niels van Royen.
• Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
• JACC Cardiovasc Interv. 2019 Nov 25; 12 (22): 2272-2282.

ObjectivesThe aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year.BackgroundUp to 24% of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non-ST-segment elevation acute coronary syndrome-like intervention strategy.MethodsIn this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months.ResultsIn the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4% [interquartile range: 0.0% to 2.5%] vs. 0.4% [interquartile range: 0.0% to 3.5%]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 ± 6.5% vs. 59.9 ± 5.4%; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7% vs. 4.4%, respectively; p = 1.00).ConclusionsAt follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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