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European Heart Journal Advance Access originally published online on March 16, 2006
European Heart Journal 2006 27(8):901-904; doi:10.1093/eurheartj/ehi829
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Aborted myocardial infarction: a new target for reperfusion therapy

Freek W.A. Verheugt1,*, Bernard J. Gersh2 and Paul W. Armstrong3

1Heartcenter, Department of Cardiology, University Medical Center, St Radboud, Nijmegen, The Netherlands
2Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
3Division of Cardiology, University of Alberta, Edmonton, Canada

Received 3 November 2005; revised 9 February 2006; accepted 16 February 2006; online publish-ahead-of-print 16 March 2006.

* Corresponding author. Tel: +31 24 3614220; fax: +31 24 3540537. E-mail address: f.verheugt{at}cardio.umcn.nl

Abstract

Reperfusion therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. Myocardial necrosis is usually confirmed and quantified by myocardial enzyme release in plasma. However, over 10% of patients treated with reperfusion therapy fail to develop an enzyme rise, but do exhibit transient ECG changes, which are consistent with an aborted myocardial infarction. The earlier the reperfusion therapy is instituted, the higher the incidence of aborted infarction. Treatment within an hour after symptom onset may result in 25% of aborted infarction and is in combination with complete (70%) ST-segment resolution associated with better survival. This endpoint is easy to define and occurs promptly in time. The faster that effective treatment is initiated, the more likely aborted infarction will occur. Given that mortality, re-infarction, and stroke are declining in incidence, we suggest the introduction of aborted infarction as an endpoint in clinical trials of ST-elevation acute coronary syndromes.

Key Words: Myocardial infarction • Reperfusion therapy • Creatine kinase • Abortion


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