Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

Abstract

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.

Coexistence of acute takotsubo syndrome and acute coronary syndrome

“…Finally, the magnitude of troponin elevation in patients with coexisting TS‐ACS was modest and not significantly different from patients with isolated TS. This unexpected finding is probably the consequence of spontaneous culprit artery reperfusion in TS‐ACS patients . In support of this explanation, eight of nine (89%) TS‐ACS patients had TIMI 3 flow in the culprit artery at initial angiography.…”

Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

“…17 In a large prospective nationwide survey of 2361 consecutive STelevation-acute coronary syndrome patients, 405 (17%) patients were found to have spontaneous reperfusion. 20 This study has few limitations. First, a single center study with limited number of sample size.…”

Rare and Unpredictable Cardiac Complication After Successful Elective Percutaneous Coronary Intervention: A Case Report

“…Cases of rapid healing after coronary dissection during PCI and spontaneous recanalizations during ST-elevation AMI have been reported [9][10][11]. Spontaneous reperfusion in the setting of STelevation acute coronary syndrome is reported in up to 30% of patients, with very few specific recommendations, although with favorable outcomes despite not undergoing immediate reperfusion [12].…”