Blondheim DS, et al. - Researchers here compared the characteristics, management, and outcome of transient ST-elevation (TSTEMI) vs persistent ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction. Findings revealed TSTEMI to be an acute coronary syndrome distinct from NSTEMI and STEMI. It is characterized by fewer risk factors, a similar extent of coronary artery disease to STEMI, but is associated with less myocardial damage and predicts a better outcome.

• Registry comprising all consecutive acute myocardial infarctions (AMI) patients admitted during 2009-2014 was analyzed.
• Comparison of the characteristics, management and outcome of TSTEMI patients with those of STEMI and NSTEMI patients was performed.
• The registry included 1,847 AMI patients; of these, 1,073 patients sustained a STEMI (58%), 649 had NSTEMI (35%) and 126 presented as TSTEMI (6.9%).
• TSTEMI patients compared to NSTEMI and STEMI patients were younger (56.5 vs 62.8 [p < 0.001] and 59.5-years [p < 0.02], respectively), smoked more (77.8 vs 54.0 [p < 0.001] and 62.1% [p<0.0005]), fewer were hypertensive (52.4 vs 74.2% and 58.8%, both p<0.001) and diabetic (26.2% vs 47.7% [p < 0.0001] and 36.9% [p<0.02]).
• TSTEMI patients were similar to STEMI patients regarding the extent of coronary artery disease except for less involvement of the left anterior descending artery (p < 0.001), but compared to NSTEMI patients, TSTEMI patients had less extensive coronary artery disease.
• Researchers noted that TSTEMI involved less myocardial damage by troponin-T level (p < 0.005) with better cardiac function (LVEF- 61% vs 55% and 49%, both p < 0.0001).
• Among TSTEMI, mortality was lower both in-hospital (0 vs 2.3% [p=NS] and 4.2% [p<0.01]) and long-term (4.8% vs 14.7% and 14.2%, both p < 0.003) at a median of 36 months.