Anatomic distribution of culprit lesions in patients with non-ST-segment elevation myocardial infarction and normal
Abdelmoniem Moustafa1, Bernard Abi-Saleh1, Mohammad El-Baba1
11 Division of Internal Medicine, 2 Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
Insights
Predictors of culprit lesions in non-ST-elevation myocardial infarction (NSTEMI) include prior coronary artery disease (CAD), male gender, and abnormal admission ECG. Abnormal ECGs correlate with multi-vessel disease, while normal ECGs suggest LCX involvement or normal coronaries.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Non-ST-elevation myocardial infarction (NSTEMI) patients often present with culprit lesions in the left anterior descending (LAD) artery or multi-vessel disease, especially with ST depression.
- However, a significant portion of left circumflex (LCX) artery infarctions occur with normal ECGs.
Purpose of the Study:
- To identify predictors of culprit lesions in NSTEMI patients.
- To correlate ECG findings with echocardiographic and clinical characteristics.
Main Methods:
- Retrospective analysis of 118 NSTEMI patients admitted between June 2012 and December 2013.
- Admission ECGs were interpreted by a blinded electrophysiologist.
- Patients were categorized into normal or abnormal ECG groups.
Main Results:
- A culprit lesion was identified in 86% of patients, more frequent in the abnormal ECG group (91.5% vs. 76.6%).
- Abnormal ECGs were associated with a higher incidence of two and three-vessel disease.
- Prior CAD history, male gender, and abnormal admission ECG were independent predictors of culprit lesions.
Conclusions:
- Prior CAD, male gender, and abnormal admission ECG are key predictors for culprit lesions in NSTEMI.
- Abnormal ECGs indicate more extensive coronary artery disease (two or three-vessel disease).
- Normal admission ECGs may suggest LCX involvement or normal coronary arteries, without impacting secondary outcomes.
Background:
In patients presenting with non-ST-elevation myocardial infarction (NSTEMI), left anterior descending (LAD) coronary artery and three-vessel disease are the most commonly encountered culprit lesions in the presence of ST depression, while one third of patients with left circumflex (LCX) artery related infarction have normal ECG. We sought to determine the predictors of presence of culprit lesion in NSTEMI patients based on ECG, echocardiographic, and clinical characteristics.
Methods:
Patients admitted to the coronary care unit with the diagnosis of NSTEMI between June 2012 and December 2013 were retrospectively identified. Admission ECG was interpreted by an electrophysiologist that was blinded to the result of the coronary angiogram. Patients were dichotomized into either normal or abnormal ECG group. The primary endpoint was presence of culprit lesion. Secondary endpoints included length of stay, re-hospitalization within 60 days, and in-hospital mortality.
Results:
A total of 118 patients that were identified; 47 with normal and 71 with abnormal ECG. At least one culprit lesion was identified in 101 patients (86%), and significantly more among those with abnormal ECG (91.5% vs. 76.6%, P=0.041).The LAD was the most frequently detected culprit lesion in both groups. There was a higher incidence of two and three-vessel disease in the abnormal ECG group (P=0.041).On the other hand, there was a trend of higher LCX involvement (25% vs. 13.8%, P=0.18) and more normal coronary arteries in the normal ECG group (23.4% vs. 8.5%, P=0.041). On multivariate analysis, prior history of coronary artery disease (CAD) [odds ratio (OR) 6.4 (0.8-52)], male gender [OR 5.0 (1.5-17)], and abnormal admission ECG [OR 3.6 (1.12-12)], were independent predictors of a culprit lesion. There was no difference in secondary endpoints between those with normal and abnormal ECG.
Conclusions:
Among patients presenting with NSTEMI, prior history of CAD, male gender and abnormal admission ECG were independent predictors of a culprit lesion. An abnormal ECG was significantly associated with two and three-vessel disease, while normal ECG was more associated with LCX involvement or normal angiogram. Admission ECG did not impact secondary outcomes.
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