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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

24.8K

Relationship between infarct artery location, acute total coronary occlusion, and mortality in STEMI and NSTEMI

Jarosław Karwowski, Marek Gierlotka, Mariusz Gąsior

    Polish Archives of Internal Medicine
    |May 6, 2017
    PubMed

    Insights

    Total coronary occlusion impacts myocardial infarction outcomes differently based on ST-segment elevation. Except for the LAD in STEMI, total IRA occlusion did not increase mortality after PCI.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Acute Coronary Syndromes

    Background:

    • Total coronary occlusion of the infarct-related artery (IRA) can influence outcomes in myocardial infarction (MI).
    • Outcomes may differ between non-ST-elevation MI (NSTEMI) and ST-elevation MI (STEMI) patients undergoing percutaneous coronary intervention (PCI).

    Purpose of the Study:

    • To evaluate the impact of IRA total occlusion on MI outcomes.
    • To compare outcomes based on the presence of ST-segment elevation and culprit lesion location.

    Main Methods:

    • Analysis of 4581 STEMI and 2717 NSTEMI patients from the Polish Registry of Acute Coronary Syndromes who underwent PCI.
    • Patients categorized by IRA (LAD, LCx, RCA) and pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow (total occlusion [TO; TIMI grade 0] vs. incomplete occlusion [nTO; TIMI grade ≥1]).

    Main Results:

    • Total occlusion (TO) was more prevalent in STEMI (64.4%) than NSTEMI (26.6%).
    • STEMI patients with TO of the LAD had higher 36-month mortality. STEMI and NSTEMI patients with TO of the LCx had higher in-hospital mortality. No significant differences were found for RCA occlusion.
    • Overall, 36-month mortality was not higher in patients with TO versus nTO after PCI for NSTEMI and STEMI, except for totally occluded LAD in STEMI.

    Conclusions:

    • Totally occluded IRA (TIMI flow grade 0) on baseline angiography was not associated with increased 36-month mortality after PCI for NSTEMI and STEMI compared to patent IRA.
    • An exception was noted for totally occluded LAD in STEMI patients, which was associated with higher mortality.
    Abstract

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