Impact of Acute Total Occlusion of Culprit Artery on Outcome in NSTEMI – Results From a Large National Registry
Background
The impact of acute total occlusion (TO) of culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMITO) compared to NSTEMI patients without TO (NSTEMINTO) and those with ST-segment elevation and TO (STEMITO).
Methods
Demographic, clinical and procedure-related data of patients with percutaneous coronary intervention (PCI) performed in acute myocardial infarction between 2014 and 2017 from the Polish National Registry were analysed.
Results
We evaluated 131,729 patients: NSTEMINTO (n=65,206), NSTEMITO (n=16,209) and STEMITO (n=50,314). NSTEMITO group had intermediate results compared to NSTEMINTO and STEMITO regarding: mean age (68.78±11.39 vs 65.98±11.61 vs 64.86±12.04 (years), p<0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03(%), p<0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02(%), p<0.0001) and death during PCI (0.43 vs 0.97 vs 1.76(%), p<0.0001) - for NSTEMINTO, NSTEMITO and STEMITO, respectively. However, in NSTEMITO we noticed: the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p<0.0001); left circumflex artery (LCx) most often as culprit lesion (14.09 vs 35.86 vs 25.42(%), p<0.0001) and lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57(%), p<0.0001).
Conclusions
NSTEMITO clearly differs from NSTEMINTO. It appears as an intermediate condition between NSTEMINTO and STEMITO, although NSTEMITO patients have the longest time delay to and the worst result of PCI which can be explained by the location of the culprit lesion in LCx.
Figure 1
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Visual summary. Approximately one-fifth of NSTEMI patients has acute occlusion of coronary artery, predominantly left circumflex artery; time delay to revascularization in this group is significantly extended and PCI outcome worse.
Posted 06 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
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On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 02 Dec, 2020
Impact of Acute Total Occlusion of Culprit Artery on Outcome in NSTEMI – Results From a Large National Registry
Posted 06 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
On 09 Jan, 2021
Invitations sent on 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 02 Dec, 2020
Background
The impact of acute total occlusion (TO) of culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMITO) compared to NSTEMI patients without TO (NSTEMINTO) and those with ST-segment elevation and TO (STEMITO).
Methods
Demographic, clinical and procedure-related data of patients with percutaneous coronary intervention (PCI) performed in acute myocardial infarction between 2014 and 2017 from the Polish National Registry were analysed.
Results
We evaluated 131,729 patients: NSTEMINTO (n=65,206), NSTEMITO (n=16,209) and STEMITO (n=50,314). NSTEMITO group had intermediate results compared to NSTEMINTO and STEMITO regarding: mean age (68.78±11.39 vs 65.98±11.61 vs 64.86±12.04 (years), p<0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03(%), p<0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02(%), p<0.0001) and death during PCI (0.43 vs 0.97 vs 1.76(%), p<0.0001) - for NSTEMINTO, NSTEMITO and STEMITO, respectively. However, in NSTEMITO we noticed: the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p<0.0001); left circumflex artery (LCx) most often as culprit lesion (14.09 vs 35.86 vs 25.42(%), p<0.0001) and lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57(%), p<0.0001).
Conclusions
NSTEMITO clearly differs from NSTEMINTO. It appears as an intermediate condition between NSTEMINTO and STEMITO, although NSTEMITO patients have the longest time delay to and the worst result of PCI which can be explained by the location of the culprit lesion in LCx.
Figure 1
Figure 2
Figure 3