NSTEMI due to a completely occluded culprit artery (NSTEMI-OMI) was associated with similar 5-year mortality compared to other type I NSTEMI (adjHR 1.13; 95% CI 0.78-1.63; P=0.51).
Cohort (n=801)
Yes
Does the presence of an occluded culprit artery (NSTEMI-OMI) affect 5-year mortality and clinical presentation compared to non-occluded arteries (NSTEMI-NOMI) in patients with type I NSTEMI?
NSTEMI-OMI occurs in about one-third of type I NSTEMI patients and is associated with higher-risk features and earlier invasive management, which likely contributes to a 5-year mortality similar to that of NSTEMI-NOMI.
Hazard Ratio: 1.13 (95% CI 0.78–1.63)
p-value: p=0.51
BACKGROUND: The prevalence, characteristics, management, and long-term outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI) due to a completely occluded culprit coronary artery (NSTEMI-OMI) remain insufficiently characterised. METHODS: In this international multicentre study, consecutive patients with centrally adjudicated type I NSTEMI were classified as NSTEMI-OMI if they had a TIMI flow grade of 0 or 1 or grade 2 with severe coronary narrowing (> 70%) and a high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500 ng/L. Prospectively recorded chest pain characteristics, 12-lead ECG, serial hs-cTnT concentrations, time to coronary angiography/revascularisation, and 5-year mortality were compared in patients with NSTEMI-OMI versus other type I NSTEMI (NSTEMI-NOMI). RESULTS: Among 801 patients with type I NSTEMI (median age 68 years, 22.2% female), 251 patients (31.3%) had NSTEMI-OMI. Patients with NSTEMI-OMI presented more often with persistent chest pain (56.1% vs. 37.9%, p < 0.001), more often had ST-segment depression (34.3% vs. 23.0%, p < 0.001), and exhibited higher and faster rising hs-cTnT concentrations. Time from admission to coronary angiography (median 7.2 h IQR 4.7, 21.8 vs. 19.6 h IQR 6.2, 27.9, p < 0.001) and coronary revascularisation (median 8.2 h IQR 4.9, 24.0 vs. 22.0 h IQR 6.3, 46.1, p < 0.001) were both significantly shorter in patients with NSTEMI-OMI versus NSTEMI-NOMI. Five-year mortality was comparable in patients with NSTEMI-OMI versus NSTEMI-NOMI (adjHR 1.13 95% CI 0.78-1.63, p = 0.51). CONCLUSION: One in three patients with type I NSTEMI had NSTEMI-OMI. These patients more often present with very high-risk clinical, ECG, and biomarker features and receive earlier invasive management. Likely related to the latter, 5-year mortality was similar between NSTEMI-OMI and NSTEMI-NOMI.
Kirsten et al. (Wed,) conducted a cohort in Type I NSTEMI (n=801). NSTEMI-OMI (completely occluded culprit coronary artery) vs. NSTEMI-NOMI (other type I NSTEMI) was evaluated on 5-year mortality (adjHR 1.13, 95% CI 0.78-1.63, p=0.51). NSTEMI due to a completely occluded culprit artery (NSTEMI-OMI) was associated with similar 5-year mortality compared to other type I NSTEMI (adjHR 1.13; 95% CI 0.78-1.63; P=0.51).