Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry
Michał Terlecki, Wiktoria Wojciechowska, Dariusz Dudek, Zbigniew Siudak, Krzysztof Plens, Tomasz J Guzik, Tomasz Dróżdż, Jan W. Pęksa, Stanisław Bartuś, Wojciech Wojakowski, Marek Grygier, Marek Rajzer
Abstract
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 (NSTEMI TO ) compared to NSTEMI patients without TO (NSTEMI NTO ) and those with ST-segment elevation and TO (STEMI TO ). 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: NSTEMI NTO (n = 65,206), NSTEMI TO (n = 16,209) and STEMI TO (n = 50,314). The NSTEMI TO group had intermediate results compared to the NSTEMI NTO and STEMI TO 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 NSTEMI NTO , NSTEMI TO and STEMI TO , respectively. However, we noticed that the NSTEMI TO 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 NSTEMI TO group clearly differed from the NSTEMI NTO group. NSTEMI TO appears to be an intermediate condition between NSTEMI NTO and STEMI TO , although NSTEMI TO 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.