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Salari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, Shohaimi S, Mohammadi M. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:206. [PMID: 37087452 PMCID: PMC10122825 DOI: 10.1186/s12872-023-03231-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/08/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is one of the life-threatening coronary-associated pathologies characterized by sudden cardiac death. The provision of complete insight into MI complications along with designing a preventive program against MI seems necessary. METHODS Various databases (PubMed, Web of Science, ScienceDirect, Scopus, Embase, and Google scholar search engine) were hired for comprehensive searching. The keywords of "Prevalence", "Outbreak", "Burden", "Myocardial Infarction", "Myocardial Infarct", and "Heart Attack" were hired with no time/language restrictions. Collected data were imported into the information management software (EndNote v.8x). Also, citations of all relevant articles were screened manually. The search was updated on 2022.9.13 prior to the publication. RESULTS Twenty-two eligible studies with a sample size of 2,982,6717 individuals (< 60 years) were included for data analysis. The global prevalence of MI in individuals < 60 years was found 3.8%. Also, following the assessment of 20 eligible investigations with a sample size of 5,071,185 individuals (> 60 years), this value was detected at 9.5%. CONCLUSION Due to the accelerated rate of MI prevalence in older ages, precise attention by patients regarding the complications of MI seems critical. Thus, determination of preventive planning along with the application of safe treatment methods is critical.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amir Abdolmaleki
- Department of Operating Room, Nahavand School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shabnam Rasoulpoor
- Department of Psychiatric Nursing, Miandoab School of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Asghar Khaleghi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Leila Afshar Hezarkhani
- Neuroscience Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Güner A, Çörekçioğlu B, Uzun F, Kalçik M, Ulutaş AE, Akman C, Can C, Keten MF, Küp A, Gürsoy MO, Kalkan S, Çizgici AY, Kahraman S, Güner EG, Külahçioğlu Ş, Yalçin AA, Ertürk M. Clinical implication of totally occluded infarct-related coronary artery in non-ST-segment elevation myocardial infarction: the TOTAL-NSTEMI study. Coron Artery Dis 2023; 34:127-133. [PMID: 36720021 DOI: 10.1097/mca.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A subset ofpatients found to have total occlusion of the culprit artery (TOCA), present with non-ST-segment elevation myocardial infarction (NSTEMI) and elevated biomarkers. The aim of this study is to assess the effect of the TOCA in patients presenting with NSTEMI. METHODS This multicenter observational study was retrospectively conducted between 2015 and 2019. Thrombolysis in myocardial infarction (TIMI) flow grades 0-1 was defined as the TOCA. The primary end point included a combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke. RESULTS Of 3272 patients, TIMI 0-1 flow in the culprit artery was present in 488 (14.9%) patients. TOCA was more likely to be of thrombotic origin (54.1% vs. 10.3%; P < 0.001) and visible collaterals (22.5% vs. 4.4%; P < 0.001). The rates of 30-day (14.3% vs. 7.2%; P < 0.001) and 2-year (25% vs. 19.1%; P = 0.003) primary end points were significantly higher in TOCA patients. Fatal arrhythmias were remarkably higher at 30-day (8.6% vs. 4%; P < 0.001) and 2-year (9% vs. 5.2%; P = 0.001) follow-ups. Mechanical complications were also higher in patients with TOCA at 30 days (0.8% vs. 0.2%; P = 0.013). Moreover, TOCA (OR, 1.379; P = 0.001) was one of the independent predictors of MACCE in NSTEMI patients. CONCLUSION The current data suggest that patients with TOCA in the context of NSTEMI are at higher risk of MACCE, fatal arrhythmias, and mechanical complications.
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Affiliation(s)
- Ahmet Güner
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Büşra Çörekçioğlu
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Fatih Uzun
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Macit Kalçik
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum
| | - Ahmet Emir Ulutaş
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Cemalettin Akman
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Cemil Can
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Mustafa Ferhat Keten
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul
| | - Ayhan Küp
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, İzmir Katip Çelebi University, Atatürk Training and Reseach Hospital, Izmir, Turkey
| | - Semih Kalkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul
| | - Ahmet Yaşar Çizgici
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Serkan Kahraman
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Ezgi Gültekin Güner
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Şeyhmus Külahçioğlu
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul
| | - Ahmet Arif Yalçin
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
| | - Mehmet Ertürk
- University of Health Science, Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul
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McLaren JTT, Meyers HP, Smith SW. Kenichi Harumi Plenary Address at Annual Meeting of the International Society of Computers in Electrocardiology: "What Should ECG Deep Learning Focus on? The diagnosis of acute coronary occlusion!". J Electrocardiol 2023; 76:39-44. [PMID: 36436473 DOI: 10.1016/j.jelectrocard.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
According to the STEMI paradigm, only patients whose ECGs meet STEMI criteria require immediate reperfusion. This leads to reperfusion delays and significantly increases the mortality for the quarter of "non-STEMI" patients with totally occluded arteries. The Occlusion MI (OMI) paradigm has developed advanced ECG interpretation to identify this high-risk group, including examining the ECG in totality and assessing ST/T changes in proportion to the QRS. If neural networks are only developed based on STEMI databases and to identify STEMI criteria, they will simply reinforce a failed paradigm. But if deep learning is trained to identify OMI it could revolutionize patient care. This article reviews the paradigm shift from STEMI and OMI, and examines the potential and pitfalls of deep learning. This is based on the Kenichi Harumi Plenary Address at the Annual Meeting of the International Society of Computers in Electrocardiology, given by OMI expert Dr. Stephen Smith.
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Affiliation(s)
- Jesse T T McLaren
- Department of Family and Community Medicine, University Health Network, Toronto, Ontario, Canada.
| | - H Pendell Meyers
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Centre, Minneapolis, MN, USA.
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Acute Occlusion of the Infarct-Related Artery as a Predictor of Very Long-Term Mortality in Patients with Acute Myocardial Infarction. Cardiol Res Pract 2021; 2021:6647626. [PMID: 34868675 PMCID: PMC8635941 DOI: 10.1155/2021/6647626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/18/2021] [Accepted: 10/22/2021] [Indexed: 12/03/2022] Open
Abstract
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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Terlecki M, Wojciechowska W, Dudek D, Siudak Z, Plens K, Guzik TJ, Drożdż T, Pęksa J, Bartuś S, Wojakowski W, Grygier M, Rajzer M. Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry. BMC Cardiovasc Disord 2021; 21:297. [PMID: 34126930 PMCID: PMC8204478 DOI: 10.1186/s12872-021-02099-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The impact of acute total occlusion (TO) of the culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate the clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMITO) compared to NSTEMI patients without TO (NSTEMINTO) and those with ST-segment elevation and TO (STEMITO). METHODS Demographic, clinical and procedure-related data of patients with acute myocardial infarction who underwent percutaneous coronary intervention (PCI) between 2014 and 2017 from the Polish National Registry were analysed. RESULTS We evaluated 131,729 patients: NSTEMINTO (n = 65,206), NSTEMITO (n = 16,209) and STEMITO (n = 50,314). The NSTEMITO group had intermediate results compared to the NSTEMINTO and STEMITO groups regarding mean age (68.78 ± 11.39 vs 65.98 ± 11.61 vs 64.86 ± 12.04 (years), p < 0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03 (%), p < 0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02 (%), p < 0.0001) and death during PCI (0.43 vs 0.97 vs 1.76 (%), p < 0.0001)-for NSTEMINTO, NSTEMITO and STEMITO, respectively. However, we noticed that the NSTEMITO group had the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p < 0.0001) and the lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57 (%), p < 0.0001) and that the left circumflex artery (LCx) was most often the culprit lesion (14.09 vs 35.86 vs 25.42 (%), p < 0.0001). CONCLUSIONS The NSTEMITO group clearly differed from the NSTEMINTO group. NSTEMITO appears to be an intermediate condition between NSTEMINTO and STEMITO, although NSTEMITO patients have the longest time delay to and the worst result of PCI, which can be explained by the location of the culprit lesion in the LCx.
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Affiliation(s)
- Michał Terlecki
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Wiktoria Wojciechowska
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Dariusz Dudek
- Jagiellonian University Medical College, 2nd Department of Cardiology, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Tomasz J Guzik
- Jagiellonian University Medical College, Department of Internal and Agricultural Medicine, Kraków, Poland
| | - Tomasz Drożdż
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Jan Pęksa
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Stanisław Bartuś
- Jagiellonian University Medical College, 2nd Department of Cardiology, Kraków, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- 1St Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Rajzer
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland.
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Ayad SW, El Zawawy TH, Lotfy MI, Naguib AM, El Amrawy AM. Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome. Egypt Heart J 2021; 73:36. [PMID: 33826020 PMCID: PMC8026781 DOI: 10.1186/s43044-021-00160-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. Results We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). Conclusion 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.
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Affiliation(s)
- Sherif W Ayad
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Tarek H El Zawawy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed I Lotfy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M Naguib
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M El Amrawy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ahmed F, Khan MS, Ali Shah SD, Jalbani J, Ali Shah A, Shaikh GA. Frequency of Three-Vessel Disease Among Patients With Non-ST Segment Elevation Myocardial Infarction. Cureus 2020; 12:e11634. [PMID: 33381357 PMCID: PMC7757756 DOI: 10.7759/cureus.11634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA). Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05). Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.
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Almendro-Delia M, Seoane García T, Villar Calle P, García González N, Lorenzo López B, Cortés FJ, García Del Río M, Ruiz García MDP, Hidalgo Urbano RJ, García-Rubira JC. Prevalence and clinical significance of totally occluded infarct-related arteries in patients with non-ST-segment elevation acute coronary syndromes. Int J Cardiol 2020; 324:1-7. [PMID: 32931857 DOI: 10.1016/j.ijcard.2020.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 01/28/2023]
Abstract
Background Seemingly conflicting findings exist regarding the prognostic impact of totally occluded infarct-related arteries (oIRA) in non-ST elevation acute coronary syndromes (NSTE-ACS). Methods Retrospective analysis of prospective multicenter registry data comprising a single-center NSTE-ACS cohort, aimed at assessing the impact of occluded (TIMI flow 0/1) versus patent culprit vessels (pIRA, TIMI flow 2/3) on the composite endpoint of all-cause death and cardiogenic shock events at 30 days. Results Of 568 patients, 183 (32.5%) had oIRA. Male sex, refractory angina, ECG suggestive of multivessel or left main disease, and larger infarct sizes with inferior/posterolateral wall involvement, were identified as highly specific markers of oIRA. Successful culprit-lesion revascularization occurred more frequently in patent than in oIRA (90% vs. 96%; P = 0.013). Conversely, patients with oIRA more frequently achieved successful revascularization of concurrent non-IRAs including chronic total occlusions than did those with pIRA (28% vs. 3%; P = 0.0005). Multivariate analysis revealed neutral effects of oIRA on outcomes and identified incomplete revascularization as a powerful predictor of mortality. Moderation analysis revealed a significant interaction between completeness of revascularization and IRA patency, whereby among the incompletely revascularized patients, those with oIRA enjoyed a significant survival advantage over their counterparts with pIRA (11.8% vs. 28%, adjusted OR 0.34; 95% CI 0.10-0.73; Pinteraction = 0.012). Conclusions Approximately one third of NSTE-ACS patients in this cohort had oIRA. However, compared with pIRA, the occurrence of oIRA did not portend poor outcomes, likely resulting from the higher rate of incomplete revascularization and increased risk of subsequent mortality in patients with pIRA. These exploratory findings warrant further investigation.
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Affiliation(s)
- Manuel Almendro-Delia
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain; Cardiovascular Research and Clinical Trials Unit, Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena. Seville. Spain.
| | - Tania Seoane García
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain; Cardiovascular Research and Clinical Trials Unit, Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena. Seville. Spain
| | - Pablo Villar Calle
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Néstor García González
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Beatriz Lorenzo López
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Francisco Javier Cortés
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Manuel García Del Río
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Rafael J Hidalgo Urbano
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain; Cardiovascular Research and Clinical Trials Unit, Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena. Seville. Spain
| | - Juan C García-Rubira
- Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena, Seville, Spain; Cardiovascular Research and Clinical Trials Unit, Cardiology and Cardiovascular Surgery Division, Hospital Universitario Virgen Macarena. Seville. Spain
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9
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Jeong HC, Ahn JH, Kim MC, Sim DS, Park KH, Hong YJ, Kim JH, Jeong MH, Seung KB, Chang K, Ahn Y. A score for decision making during percutaneous coronary intervention in acute myocardial infarction patients with multivessel disease. Korean J Intern Med 2019; 34:324-334. [PMID: 29551055 PMCID: PMC6406104 DOI: 10.3904/kjim.2017.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/08/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND/AIMS The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD. METHODS In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD. RESULTS The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points. CONCLUSION The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.
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Affiliation(s)
- Hae Chang Jeong
- Department of Cardiology, Cardiovascular Center, Miraero 21 Hospital, Gwangju, Korea
| | - Joon Ho Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ki-Bae Seung
- Department of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Department of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Youngkeun Ahn, M.D. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-4764 Fax: +82-62-224-4764 E-mail:
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10
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Hwang H, Park C, Cho J, Jin E, Sohn I, Kim D, Kim C. Clinical characteristics of occluded culprit arteries and collaterals in patients with non‑ST‑segment elevation myocardial infarction and impact on clinical outcomes. Exp Ther Med 2018; 16:3710-3720. [DOI: 10.3892/etm.2018.6605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 01/09/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hui‑Jeong Hwang
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Chang‑Bum Park
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Jin‑Man Cho
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Eun‑Sun Jin
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Il Sohn
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Dong‑Hee Kim
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Chong‑Jin Kim
- Department of Internal Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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11
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Hung CS, Chen YH, Huang CC, Lin MS, Yeh CF, Li HY, Kao HL. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded "culprit" artery - a systemic review and meta-analysis. Crit Care 2018; 22:34. [PMID: 29422071 PMCID: PMC5806289 DOI: 10.1186/s13054-018-1944-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 01/08/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim was to determine the prevalence and impact of an occluded "culprit" artery (OCA) in patients with non-ST segment elevation myocardial infarction (NSTEMI). METHODS We searched PubMed, EMBASE, and Web of Science, with no language restrictions, up to 1 Jul. 2016. Observational cohorts or clinical trials of adult NSTEMI were eligible for inclusion to determine the prevalence if the proportion of OCA on coronary angiography was reported. Studies were further eligible for inclusion to determine the outcome if the association between OCA and clinical endpoints was reported. RESULTS Among the 60,898 patients with NSTEMI enrolled in 25 studies, 17,212 were found to have OCA. The average proportion of OCA in NSTEMI was 34% (95% CI 30-37%). Patients with OCA were more likely to have left circumflex artery as their culprit artery (odds ratio (OR) 1.65, 95% CI 1.15-2.37, p = 0.007), and this was associated with lower left ventricular ejection fraction (standard mean difference -0.29, 95% CI -0.34 to -0.34, p < 0.001), higher peak enzyme level (standard mean difference 0.43, 95% CI 0.27-0.58, p < 0.001), and higher risk for cardiogenic shock (OR 1.66, 95% CI 1.35-2.04, p < 0.001), compared with patients with a non-occlusive culprit artery. Death rate (OR 1.72, 95% CI 1.49-1.98, p < 0.001) and recurrent myocardial infarction (OR 1.7, 95% CI 1.06-2.75, p = 0.029) were also higher in patients with OCA, compared with patients with a non-occlusive culprit artery. CONCLUSIONS Patients with OCA comprised a substantial portion of the NSTEMI population. These patients present with more severe symptoms and worse clinical outcome. Whether these patients should be treated with more aggressive strategy warrants further study.
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Affiliation(s)
- Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
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12
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Khan AR, Golwala H, Tripathi A, Bin Abdulhak AA, Bavishi C, Riaz H, Mallipedi V, Pandey A, Bhatt DL. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J 2017; 38:3082-3089. [DOI: 10.1093/eurheartj/ehx418] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
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13
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Zheng G, Li Y, Takayama T, Nishida T, Sudo M, Haruta H, Fukamachi D, Okubo K, Higuchi Y, Hiro T, Saito S, Hirayama A. The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction. PLoS One 2016; 11:e0152825. [PMID: 27031514 PMCID: PMC4816424 DOI: 10.1371/journal.pone.0152825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/03/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability. Methods Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions. Results The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions. Conclusions Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion.
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Affiliation(s)
- Guian Zheng
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Department of Cardiology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Yuxin Li
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- * E-mail:
| | - Tadateru Takayama
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Toshihiko Nishida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Hironori Haruta
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Kimie Okubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Yoshiharu Higuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Takafumi Hiro
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Satoshi Saito
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Atsushi Hirayama
- Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine, Tokyo, 173-8610, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, 173-8610, Japan
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14
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Açıkgöz SK, Akboğa MK, Açıkgöz E, Yayla Ç, Şensoy B, Aydoğdu S. Red cell distribution width predicts totally occluded infarct-related artery in NSTEMI. SCAND CARDIOVASC J 2016; 50:224-9. [PMID: 26857117 DOI: 10.3109/14017431.2016.1152398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Since non-ST segment elevation myocardial infarction (NSTEMI) patients with totally occluded infarct-related artery (TO-IRA) have worse prognosis, it is important to recognize TO-IRA in NSTEMI. Red cell distribution width (RDW) and mean platelet volume (MPV) are novel markers of inflammation and oxidative stress and were associated with poor clinical outcomes in acute coronary syndrome. In the present study, association of RDW and MPV with the presence of TO-IRA in NSTEMI was investigated. Methods Data of 201 consecutive patients who underwent coronary angiography with a diagnosis of NSTEMI were analyzed. Independent predictors of TO-IRA were investigated with logistic regression analysis. Results Sixty-six (32.8%) of the patients had TO-IRA. In patients with TO-IRA, RDW and troponin-T were significantly higher and left ventricular ejection fraction (LVEF) was lower. MPV did not differ between groups. Circumflex (CX) IRA was more common in TO-IRA group. The ROC curve analysis showed that the RDW at a cut-point of 13.95% has 76% sensitivity and 66% specificity in detecting TO-IRA. RDW, troponin-T, LVEF and CX-IRA were independent predictors of TO-IRA in NSTEMI, but MPV was not. Conclusion RDW is a cheap and readily available marker that may have a role to predict TO-IRA in NSTEMI.
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Affiliation(s)
- Sadık Kadri Açıkgöz
- a Department of Cardiology , Turkiye Yüksek İhtisas Education and Research Hospital , Ankara , Turkey
| | - Mehmet Kadri Akboğa
- a Department of Cardiology , Turkiye Yüksek İhtisas Education and Research Hospital , Ankara , Turkey
| | - Eser Açıkgöz
- b Department of Cardiology , Abdurrahman Yurtaslan Oncology Education and Research Hospital , Ankara , Turkey
| | - Çağrı Yayla
- a Department of Cardiology , Turkiye Yüksek İhtisas Education and Research Hospital , Ankara , Turkey
| | - Barış Şensoy
- a Department of Cardiology , Turkiye Yüksek İhtisas Education and Research Hospital , Ankara , Turkey
| | - Sinan Aydoğdu
- a Department of Cardiology , Turkiye Yüksek İhtisas Education and Research Hospital , Ankara , Turkey
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Warren J, Mehran R, Yu J, Xu K, Bertrand ME, Cox DA, Lincoff AM, Manoukian SV, Ohman EM, Pocock SJ, White HD, Stone GW. Incidence and impact of totally occluded culprit coronary arteries in patients presenting with non-ST-segment elevation myocardial infarction. Am J Cardiol 2015; 115:428-33. [PMID: 25542393 DOI: 10.1016/j.amjcard.2014.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
Abstract
The accuracy of the 12-lead electrocardiogram in detecting coronary artery occlusion is limited. We sought to determine the incidence, distribution, and outcomes of patients who have total occlusion of the culprit artery but present with non-ST-segment elevation myocardial infarction (NSTEMI). The randomized Acute Catheterization and Urgent Intervention Triage Strategy trial enrolled 13,819 patients presenting with non-ST-segment elevation acute coronary syndromes who underwent an early invasive strategy. The present study includes 1,319 patients with baseline biomarker elevation (NSTEMI) and no history of coronary artery bypass graft who underwent percutaneous coronary intervention of a single culprit vessel. We compared the baseline characteristics and outcomes according to whether the culprit vessel was occluded (baseline Thrombolysis In Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit artery was present in 262 of 1,319 (19.9%) patients. The incidence of coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI because of right coronary, left circumflex, and left anterior descending artery disease, respectively. Patients with an occluded culprit artery were more commonly men and had ST-segment deviation ≥1 mm. One-year outcomes, including death (3.5% vs 3.0%, p = 0.68) and myocardial infarction (8.4% vs 9.6%, p = 0.47), did not differ significantly between patients with versus without occluded culprit arteries, respectively. In conclusion, the present study demonstrates that the culprit artery is totally occluded in approximately 1 in 5 patients presenting with NSTEMI and single-vessel disease; however, the presence of total occlusion in NSTEMI was not associated with an incremental hazard of death or reinfarction at 1 year.
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