Clinical Predictors of Revascularization in Patients with Aborted Myocardial Infarction

Abstract

Objectives: The objective of this study was to evaluate the clinical and angiographic profiles of patients with aborted myocardial infarction (MI) and to identify the revascularization strategy for these patients. Methodology: A total of 120 consecutive patients with aborted MI, undergoing immediate revascularization at a tertiary care cardiac center, were included in the study. Aborted MI was defined as the spontaneous resolution of ST-segment elevation by >70% on consecutive ECGs before the administration of definitive reperfusion therapy. Patients were categorized into two groups: reperfusion therapy (RT) and recanalized vessels (RV) group. The RT group included patients who underwent plain old balloon angioplasty (POBA) or stent deployment. Results: Among the 120 patients, 85.8% (103) were male, with a mean age of 48.91±11.62 years. Recanalized vessels were observed in 36.7% (44) of the patients. Compared to the RT group, patients in the RV group were relatively younger (43.41±12.68 vs. 52.09±9.7 years; p<0.001). A significantly higher proportion of patients in the RV group had anterior wall MI (AWMI) (67.1% vs. 9.5%; p<0.001) and a shorter median chest pain-to-ACS protocol time (180 [120-255] vs. 300 [180-360] minutes; p=0.003). Multivariable regression analysis identified AWMI as an independent predictor of the need for immediate revascularization, with an adjusted odds ratio of 5.74 [95% CI: 2.33-14.16]. Conclusion: Our study concludes that patients with aborted MI can be classified based on their clinical profiles to determine the timing and strategy of revascularization. Patients were categorized into two groups: those with recanalized vessels (RV) on angiography and those requiring revascularization therapy (RT), either POBA or stent deployment. Several predictors, such as younger age at presentation, type 2 diabetes mellitus, smoking, family history of premature coronary artery disease, dyslipidemia, and the time elapsed after chest pain onset, can help pre-classify patients into high-risk categories requiring immediate revascularization or low-risk categories eligible for early invasive strategies.