Why the study?
The impact of acute total occlusion of the culprit artery in NSTEMI was not fully established.
Does acute total occlusion of the culprit artery in NSTEMI affect clinical presentation, time delays, and PCI outcomes compared to NSTEMI without total occlusion and STEMI with total occlusion?
Does acute total occlusion of the culprit artery in NSTEMI affect clinical presentation, time delays, and PCI outcomes compared to NSTEMI without total occlusion and STEMI with total occlusion?
NSTEMI with total occlusion represents an intermediate clinical phenotype between NSTEMI without total occlusion and STEMI with total occlusion, but is associated with the longest delays to treatment and worst angiographic outcomes.
NSTEMI with culprit TO may signal higher-risk phenotype needing prompt evaluation; leaves open whether expedited reperfusion improves LCx-related outcomes.
Background The impact of acute total occlusion (TO) of culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate 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 percutaneous coronary intervention (PCI) performed in acute myocardial infarction 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). NSTEMI TO group had intermediate results compared to NSTEMI NTO and STEMI TO 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, in NSTEMI TO we noticed: the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p<0.0001); left circumflex artery (LCx) most often as culprit lesion (14.09 vs 35.86 vs 25.42(%), p<0.0001) and lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57(%), p<0.0001). Conclusions NSTEMI TO clearly differs from NSTEMI NTO . It appears as 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 LCx.
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Terlecki et al. (2021) studied this question.
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