Non-ST Elevation Myocardial Infarction With Occluded Culprit Artery: A Continuum of Mortality Risk Across the
Luís Graça-Santos1, Catarina Ruivo, Fernando Montenegro-Sá
1Leiria Hospital Centre - Rua de Santo André, 2410-197, Leiria, Portugal. luismscp1@gmail.com.
Insights
Patients with non-ST elevation myocardial infarction (NSTEMI) and an occluded culprit artery (OCA) face higher in-hospital mortality risks. This risk is intermediate between STEMI patients and those with NSTEMI without OCA.
Area of Science:
- Cardiology
- Acute Coronary Syndromes
- Myocardial Infarction
Background:
- Occluded culprit artery (OCA) in non-ST elevation myocardial infarction (NSTEMI) may indicate a higher risk profile.
- Understanding the comparative outcomes of NSTEMI with and without OCA versus ST-segment elevation myocardial infarction (STEMI) is crucial for risk stratification.
Purpose of the Study:
- To compare in-hospital (IH) mortality rates among patients with STEMI, NSTEMI with OCA, and NSTEMI without OCA.
- To evaluate the risk continuum of IH mortality across these acute coronary syndrome presentations.
Main Methods:
- Retrospective analysis of 14,037 patients from the Portuguese National Registry of Acute Coronary Syndromes.
- Categorization into three groups: STEMI (n=8616), OCA-NSTEMI (n=1309), and non-OCA NSTEMI (n=4112).
- Multivariate analysis to assess adjusted risk of IH all-cause mortality.
Main Results:
- Twenty-four percent of NSTEMI patients had an OCA, with the left circumflex artery being more frequently implicated.
- OCA-NSTEMI patients received percutaneous revascularization less often than STEMI patients.
- Adjusted IH mortality risk was higher in STEMI vs. OCA-NSTEMI (OR 2.34) and in OCA-NSTEMI vs. non-OCA NSTEMI (OR 2.25).
Conclusions:
- Patients with OCA-NSTEMI exhibit worse IH outcomes than non-OCA NSTEMI patients.
- OCA-NSTEMI patients demonstrate better IH outcomes compared to STEMI patients.
- A continuum of increased IH mortality risk exists across STEMI, OCA-NSTEMI, and non-OCA NSTEMI groups.
Background:
Non-ST segment elevation myocardial infarction (NSTEMI) patients presenting with occluded culprit artery (OCA) may be at higher risk for worse outcomes. We sought to compare in-hospital (IH) mortality between patients presenting with NSTEMI with and without OCA, and ST-segment elevation myocardial infarction (STEMI).
Methods:
This retrospective analysis studied 14,037 patients enrolled in the Portuguese National Registry of Acute Coronary Syndromes. Three groups were defined: (A) STEMI (n = 8616); (B) OCA-NSTEMI (n = 1309); and (C) non-OCA NSTEMI (n = 4112). Baseline characteristics, therapeutic strategies, and outcomes were compared. Multivariate analysis was performed to assess the risk of IH all-cause mortality across the prespecified groups.
Results:
Twenty-four percent of NSTEMI patients presented with OCA. The left circumflex artery was more frequently the culprit artery in group B (12.4% A vs 34.5% B vs 26.0% C; P<.001) and this group was also less likely to receive percutaneous revascularization (95.2% A vs 69.7% B vs 83.2% C; P<.001). The incidence of left ventricular systolic dysfunction was higher in group A and lower in group C (19.9% A vs 12.2% B vs 8.1% C; P<.001). The adjusted risk of IH mortality was significantly higher in group A when compared with group B (3.9% A vs 1.8% B; odds ratio, 2.34; 95% confidence interval, 1.34-4.07; P<.01) and in group B when compared with group C (1.8% B vs 0.9% C; odds ratio, 2.25; 95% confidence interval, 1.17-4.35; P=.02).
Conclusion:
OCA-NSTEMI patients had worse IH outcomes than non-OCA NSTEMI patients and better IH outcomes than STEMI patients, suggesting the existence of a continuum of increased risk of IH mortality across these groups.
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