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European Heart Journal Advance Access published online on March 16, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi829
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received November 3, 2005
Revised February 9, 2006
Accepted February 16, 2006

Current opinion

Aborted myocardial infarction: a new target for reperfusion therapy

Freek W.A. Verheugt 1 *, Bernard J. Gersh 2, and Paul W. Armstrong 3

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

* To whom correspondence should be addressed.
Freek W.A. Verheugt, E-mail: 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.

Keywords: Myocardial infarction; Reperfusion therapy; Creatine kinase; Abortion.
The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
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