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Acute Occlusion of the Infarct-Related Artery as a Predictor of Very Long-Term Mortality in Patients with Acute
Nikola Kos1, Ivan Zeljković1, Tomislav Krčmar2,3
1Department of Cardiovascular Diseases, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia.
Insights
Total infarct-related artery occlusion did not impact long-term mortality in acute myocardial infarction patients. However, non-ST-elevation myocardial infarction (NSTEMI) showed higher mortality than ST-elevation myocardial infarction (STEMI), regardless of artery presentation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Acute myocardial infarction (AMI) management focuses on reperfusion therapy.
- The role of infarct-related artery (IRA) occlusion in very long-term outcomes remains debated.
- Distinguishing between occlusive and non-occlusive IRA presentations is crucial for risk stratification.
Purpose of the Study:
- To investigate the impact of angiographically verified IRA occlusion on very long-term outcomes in patients with STEMI and NSTEMI.
- To compare mortality rates between occlusive myocardial infarction (OMI) and non-occlusive myocardial infarction (NOMI) presentations.
- To assess the influence of IRA occlusion on mortality within STEMI and NSTEMI subgroups.
Main Methods:
- A single-center, registry-based study included 2450 patients with acute coronary syndrome treated with PCI (June 2011-December 2016).
- Patients were categorized into OMI (100% stenosis, TIMI flow 0) and NOMI (50-99% stenosis, TIMI 1-3 flow) based on IRA status.
- Very long-term outcomes were analyzed with a median follow-up of 4.7 years.
Main Results:
- No significant difference in cardiovascular or all-cause mortality was observed between OMI and NOMI groups (p=0.374).
- Patients with NSTEMI exhibited significantly higher very long-term mortality compared to STEMI patients (21.6% vs 18.1%, p=0.029).
- STEMI patients predominantly presented with OMI (88%), while NSTEMI patients more frequently had NOMI (66.81%).
Conclusions:
- Total IRA occlusion is not associated with increased long-term mortality in AMI patients.
- NSTEMI diagnosis is linked to higher mortality, irrespective of the IRA's angiographic presentation (OMI/NOMI).
- IRA occlusion did not significantly affect mortality rates within either STEMI or NSTEMI patient groups.
Aim:
The survey's aim was to examine the significance of infarct-related artery (IRA) occlusion (verified angiographically) on very long-term outcomes of patients with acute myocardial infarction, within the STEMI and NSTEMI diagnosis.
Methods:
A single-center, nonrandomized, registry-based study on patients treated for acute coronary syndrome with percutaneous coronary intervention between June 2011 and December 2016 was conducted. Patients with angiographically proven IRA occlusion (100% stenosis with TIMI flow 0 distal to occlusion) were categorized as occlusive myocardial infarction (OMI) and patients with patent IRA (50-99% stenosis with TIMI 1-3 flow) were categorized as nonocclusive myocardial infarction (NOMI) and very long-term outcomes were analyzed. Data were collected prospectively from the hospital's PCI registry and the database of the Croatian Institute of Public Health.
Results:
A total of 2450 patients were included in the study. 796 (32.5%) patients had NOMI and 1654 patients (67.5%) had OMI. According to ECG changes, 1534 patients presented with STEMI (62,6%) and 916 with NSTEMI (37,8%). 88% of STEMI patients presented with OMI and 12% with NOMI, while patients with NSTEMI in 33,8% presented with OMI and in 66,81% with NOMI. A median follow-up was 4.7 years. There was no significant difference in cardiovascular mortality between the groups (14.8% vs 13.1%; OMI vs NOMI, respectively; p=0.374) neither in all-cause mortality (19% vs 21.5%; OMI vs NOMI, respectively; p=0.374). Patients with NSTEMI had a significantly higher very long-term mortality (21.6% vs 18.1%; NSTEMI vs STEMI, respectively; p=0.029).
Conclusion:
The main findings of the study are as follows: (1) total IRA occlusion was not associated with higher long-term mortality; (2) NSTEMI was associated with a higher mortality rate compared with STEMI, independent of angiographic presentation (OMI/NOMI); (3) IRA occlusion was not associated with significantly higher mortality rates in patients with STEMI and NSTEMI, respectively.
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