Key result
Absence of ST-segment changes in acute LCX occlusion was associated with a longer median door-to-balloon time (245 vs 93 and 97 min; P<0.0001), while ST-depression had worse 1-year MACCE (29%; P=0.0034).
Cohort (n=138)
No
A significant proportion of patients with acute LCX occlusion lack typical ST-segment changes on initial ECG, which can lead to delayed reperfusion.
Background Acute coronary syndrome (ACS) with occlusion of the left circumflex coronary artery (LCX) poses diagnostic problems that may lead to a delay in reperfusion. Methods and Results From a group of 1,269 consecutive patients with ACS, 138 patients with ACS due to LCX occlusion were analyzed for clinical, electrocardiographic, and angiographic presentations, as well as door-to-balloon (DTB) time. Electrocardiographic changes were classified into 4 patterns: ST-segment elevation in inferior/lateral leads (ST-E); ST-segment depression in V1–V4 (ST-D); no significant ST changes (No-ST); and others. The No-ST group was associated with a longer DTB time (P<0.0001) compared with the ST-E and ST-D groups. Compared with the No-ST and ST-E groups, the ST-D group presented with a more advanced Killip class (P=0.003), greater peak creatine phosphokinase (P=0.007) and peak creatine kinase-MB (P=0.006), more frequent proximal LCX occlusion (P=0.007), and worse 1-year outcomes (P=0.0034). Conclusions One-third of ACS patients with LCX occlusion showed no ST-segment changes, resulting in significantly longer DTB time. Improving diagnostic accuracy is challenging but critical to avoid delayed reperfusion in these patients without electrocardiographic changes.
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Komatsu et al. (2022) conducted a cohort in Acute coronary syndrome due to left circumflex coronary artery (LCX) occlusion (n=138). No significant ST-segment changes on initial ECG (No-ST) vs. ST-segment elevation in inferior/lateral leads (ST-E) and ST-segment depression in V1-V4 (ST-D) was evaluated on Door-to-balloon (DTB) time (minutes) (p=<0.0001). Absence of ST-segment changes in acute LCX occlusion was associated with a longer median door-to-balloon time (245 vs 93 and 97 min; P<0.0001), while ST-depression had worse 1-year MACCE (29%; P=0.0034).
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