The objective of this study was to determine the best time to revascularize a patient who is undergoing an acute coronary syndrome (ACS) with transient ST segment elevation.

This population hovers around 15% of STEMI patients. The question is whether to reduce infarction area (or potential reinfarction) with an immediate intervention, or to delay intervention to allow plaque stabling and reduce thrombus load. The current guidelines do not include this scenario, which is what makes this study so interesting from a physiopathological point of view.

The study included 142 patients arriving with ST elevation MI and chest pain whose symptoms resolved upon emergency handling: ST normalized and chest pain disappeared. Patients were then randomized to angiography and immediate revascularization vs. delayed revascularization. Primary end point was infarction size by MRI at 4 days, and clinical end point was at 30 days.

Read also: EuroPCR 2018 | RADIANCE-HTN SOLO: Renal Denervation Guided Through Intravascular Ultrasound.

There were no differences in primary end point between both branches and they both had favorable short term clinical results. Only 5.6% of patients randomized to the delayed strategy needed to be transferred to the cath lab for an emergency procedure due to changes in EKG or symptoms of repeat STEMI.  

Original title: What is the optimal timing of revascularisation in transient STEMI? The TRANSIENT trial.

Presenter: Lemkes Jorrit.

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