Prognosis of Patients With Left Circumflex Artery Acute Myocardial Infarction in Relation to ST-Segment on Admission
Ofer Kobo1, Erez Marcusohn, Ariel Roguin
1Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. Ofermkobo@gmail.com.
Insights
Patients with non-ST elevation myocardial infarction (NSTEMI) due to left circumflex artery disease have similar long-term mortality to those with ST-elevation myocardial infarction (STEMI). Prompt treatment for NSTEMI is recommended.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Left circumflex artery (LCX) occlusion can cause myocardial infarction (MI) without ST-segment elevation, and its clinical outcomes are not well understood.
- Understanding outcomes for LCX-related MI, with or without ST-segment elevation, is crucial for patient management.
Purpose of the Study:
- To compare clinical outcomes between patients with acute myocardial infarction (MI) due to LCX occlusion or stenosis, differentiating between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI).
Main Methods:
- Retrospective cohort study of 897 patients with LCX-related MI treated between 2009 and 2019.
- Outcomes assessed included recurrent percutaneous coronary intervention (PCI), acute coronary syndrome (ACS) hospitalization, and mortality.
- Logistic regression analysis identified predictors of 1-year mortality.
Main Results:
- NSTEMI patients (56.6%) had higher 1-year rates of ACS hospitalization (15.8% vs 11.1%) and PCI (20.9% vs 14.4%) compared to STEMI patients.
- STEMI patients had higher 30-day mortality (3.9% vs 1.7%), but 1-year mortality was similar (6.7% vs 5.6%).
- Left dominant circulation and diabetes mellitus were independent predictors of 1-year mortality.
Conclusions:
- One-year mortality is similar for NSTEMI and STEMI patients with LCX disease.
- Left dominant circulation is linked to increased short- and long-term mortality.
- NSTEMI patients warrant prompt and aggressive treatment comparable to STEMI patients.
Background:
Total thrombotic occlusion of the left circumflex (LCX) artery may present without ST-segment elevations; the clinical outcomes of such patients remain unclear.
Objective:
To examine the difference in clinical outcomes between patients with acute myocardial infarction (MI) due to LCX occlusion or stenosis with and without ST-segment elevation.
Methods:
The present study is based on an observational, retrospective cohort comprising all patients admitted to 2 centers between 2009 and 2019 with MI due to LCX disease. Clinical outcomes included recurrent percutaneous coronary intervention (PCI), hospitalization due to acute coronary syndrome (ACS), and mortality. Risk factors for mortality were assessed using logistic regression analysis.
Results:
During the study period, a total of 897 patients with LCX-related MI were treated. Most (56.6%) presented with non-ST segment elevation MI (NSTEMI), which was associated with higher rates of 1-year hospitalization for ACS (15.8% vs 11.1%; P=.05) and PCI (20.9% vs 14.4%; P=.05) compared with ST-segment elevation MI (STEMI) patients. STEMI was associated with higher 30-day mortality compared with NSTEMI (3.9% vs 1.7%, respectively; P=.05), with no difference in mortality after 1 year (6.7% vs 5.6%, respectively; P=.55). Multivariate analysis found left dominant circulation (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.4-4.7) and diabetes mellitus (OR, 2.13; 95% CI, 1.2-3.6) to be independent predictors for 1-year mortality.
Conclusion:
Patients suffering from NSTEMI and STEMI related to LCX occlusion or stenosis have similar 1-year mortality. Left dominant circulation was associated with higher short- and long-term mortality. These results suggest that a substantial population of patients who present as NSTEMI should be treated as promptly and aggressively as STEMI patients.
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