Optimal Revascularization Time in Transient STEMI

Patients admitted with transient ST elevation MI and later normalize completely (symptimos disappear before being treated) are those we normally say are “undergoing a non-ST elevation MI”. This is complex, because revascularization time remains nuclear, as is whether to treat them as STEMI or non-STEMI patients.

The aim of this study was to determine the effects of an immediate strategy, compared against a differed strategy, quantifying infarct size with cardiac magnetic resonance.


The study randomized 142 patients with transient ST elevation MI to immediate (as if it were primary PCI in persistent STEMI patients) mean 0.3 hours vs. invasive differed strategy (as non-STEMI patients) with mean 22.7 hours.

Read also: The Ten Commandments for the Fourth Universal Definition of Infarction.

Infarction size measured by CMR at day 4 after the event was small and similar between strategies.


Neither were there differences in terms of major cardiac events, a combination of death, reinfarction or revascularization at 30 days (2.9% vs. 2.8%, p=1.00).

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Only 4 patients in the deferred group (5.6%) required emergency intervention given their signs and symptoms while waiting the angiography.



Globally, infarct size in patients presenting transient ST elevation MI is small and revascularization strategy, whether immediate or differed, has no influence. Hard events at short term were low and similar between the groups.


Original title: Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial.

Reference: Jorrit S. Lemkes et al. European Heart Journal (2019) 40, 283–291.


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