Clinical decision-making in patients with non-ST-segment-elevation myocardial infarction: more than risk
Guangze Xiang1, Gaoyang Cao2, Menghan Gao3
1Department of Cardiology, Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Insights
Total occlusion (TO) of the culprit artery in non-ST-segment-elevation myocardial infarction (NSTEMI) is linked to multivessel disease (MVD) and worse outcomes. Regional wall motion abnormalities predict TO, while risk scores correlate with MVD prevalence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Non-ST-segment-elevation myocardial infarction (NSTEMI) management involves risk stratification and assessment of coronary artery disease extent.
- The significance of total occlusion (TO) of the culprit artery and its association with multivessel disease (MVD) in NSTEMI requires further elucidation.
Purpose of the Study:
- To investigate the relationship between risk stratification, culprit artery TO, and MVD in NSTEMI patients.
- To identify predictors of TO and MVD in NSTEMI.
- To evaluate the clinical impact of TO on patient outcomes.
Main Methods:
- Retrospective analysis of 835 NSTEMI patients undergoing percutaneous coronary intervention (PCI).
- Data collected on demographics, clinical presentation, and procedural outcomes.
- Univariate and multivariate regression analyses were used to identify predictors of TO and MVD.
Main Results:
- 41.8% of patients presented with TO of the culprit vessel.
- Patients with TO were more likely to have MVD (P=0.004).
- Regional wall motion abnormalities (RWMA) were a significant independent predictor of TO (OR=4.022).
- Age, hypertension, and diabetes mellitus were independent predictors of MVD.
- Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores correlated with MVD prevalence but not TO.
- Patients with TO had a higher risk of out-of-hospital cardiac death at 2-year follow-up.
Conclusions:
- TIMI and GRACE risk scores are not associated with culprit artery TO but correlate with MVD prevalence in NSTEMI.
- RWMA is an independent predictor of acute TO in NSTEMI.
- Culprit artery TO in NSTEMI is associated with MVD and poorer clinical outcomes.
Objective:
This study aims to explore the association between risk stratification and total occlusion (TO) of the culprit artery and multivessel disease (MVD) in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and to obtain more data on clinical decision-making in addition to risk stratification.
Methods:
We retrospectively collected data from 835 patients with NSTEMI admitted to our hospital between 1 January 2016 and 1 August 2022. All patients underwent percutaneous coronary intervention (PCI) within 72 h of admission. We excluded patients with a history of cardiac arrest, myocardial infarction, coronary artery bypass grafting, or PCI. Univariate and multivariate regression analyses were performed to determine the predictors of acute TO and MVD.
Results:
A total of 349 (41.8%) patients presented with a TO culprit vessel, whereas 486 (58.2%) had a patent culprit vessel. Thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk stratifications were similar between the two groups of patients (P = 0.712 and 0.991, respectively). The TO infarct vessel was more commonly observed in the left circumflex artery. Patients with TO were more likely to develop MVD (P = 0.004). Univariate and multivariate linear regression analyses were performed to evaluate the role of variables in the presence of TO and MVD in patients with NSTEMI. Regional wall motion abnormalities (RWMAs) [odds ratio (OR) = 4.022; confidence interval (CI): 2.782-5.813; P < 0.001] were significantly linked to TO after adjusting for potentially related variables. Furthermore, age (OR = 1.032; CI: 1.018-1.047; P < 0.001), hypertension (OR = 1.499; CI: 1.048-2.144; P = 0.027), and diabetes mellitus (OR = 3.007; CI: 1.764-5.125; P < 0.001) were independent predictors of MVD in patients with NSTEMI. TIMI and GRACE risk scores were related to MVD prevalence in the multivariate logistic regression model. Patients with a TO culprit vessel had a higher risk of out-of-hospital cardiac death after a 2-year follow-up compared with those without a TO culprit vessel (P = 0.022).
Conclusion:
TIMI and GRACE risk scores were not associated with a TO of the culprit artery; however, they correlated with the prevalence of MVD in patients with NSTEMI. RWMA is an independent predictor of acute TO in patients with NSTEMI. Patients with a TO culprit vessel had worse clinical outcomes than those without a TO culprit vessel.
More Related Videos
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:22Myocarditis IV: Nursing Management
01:27Myocarditis II: Clinical features and Diagnostic Tests
01:14Myocarditis III: Medical Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Ethical Dilemmas II
01:18Endocarditis III: Medical Management