Key result
T-wave imbalance (OR 3.871; 95% CI 1.820-8.231) and STV5 + STV6 ≥ 2.5 mm (OR 2.595; 95% CI 1.297-5.192) were independent predictors of acute complete occlusion of the culprit LCX in NSTEMI patients.
Why the study?
Clinical features and ischemic ECG alterations in NSTEMI patients with complete blockage of a culprit left circumflex artery are unknown.
What are the clinical and electrocardiographic predictors of acute total occlusion of the culprit LCX in NSTEMI patients?
Observational (n=5,215)
No
What are the clinical and electrocardiographic predictors of acute total occlusion of the culprit LCX in NSTEMI patients?
Odds Ratio: 3.871 (95% CI 1.82–8.231)
In NSTEMI patients with acute total occlusion, the LCX is the most common culprit vessel and can be predicted by specific ECG changes including STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.
ECG parameters may aid LCX occlusion detection in NSTEMI; leaves open prospective validation before practice change.
BACKGROUND: Complete blockage of the culprit coronary artery is associated with 30% of NSTEMI (non-ST-segment elevation myocardial infarction) patients. The culprit vessel in the left circumflex artery (LCX) is more prevalent in this subset of individuals. These people's clinical features and ischemia alterations on electrocardiography (ECG) are unknown. The goals of this study were to examine clinical features and identify predicted ECG abnormalities in NSTEMI patients with complete blockage of the culprit LCX. METHODS: This study enrolled 5215 consecutive NSTEMI patients' data. A total of 180 people were diagnosed with acute total occlusion of the culprit artery (ATOCA). Based on the culprit vessel, the patients were classified into three groups:ATOCA in the LAD (n = 46), ATOCA in the RCA (n = 38) and ATOCA in the LCX (n = 96). Furthermore, basic clinical data, ECG alterations, and the occurrence of major adverse cardiac events (MACEs) were gathered and examined. RESULTS: In this single-center investigation, we discovered that ATOCA was more prevalent in patients with NSTEMI in the LCX group. Patients with culprit LCX were more prone to having multivessel coronary disease (p = 0.015), poorer LVEF (p = 0.040), and a lower revascularization success rate (p = 0.019) during hospitalization, although there were no significant differences in MACEs in short and long follow-up. STV5 + STV6 ≥ 2.5 mm (OR = 2.595, 95% CI: 1.297 ~ 5.192) and T-wave imbalance (defined as an upright T-wave in V1 with an amplitude larger than V6 (T1-T6 ≥ 1 mm) recorded from the P-R interval)(OR = 3.871, 95% CI: 1.820 ~ 8.231) were shown to be independent predictors of NSTEMI patients with acute complete blockage of the culprit LCX in multivariate regression analysis. CONCLUSION: The LCX is the most prevalent culprit vessel with acute complete occlusion in NSTEMI patients, yet it has little effect on clinical outcomes. This subset of patients may be predicted by STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.
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Deng et al. (2025) conducted an observational in Non-ST-segment elevation myocardial infarction (NSTEMI) with acute total occlusion of the culprit artery (n=5,215). T-wave imbalance and STV5 + STV6 ≥ 2.5 mm on ECG vs. Absence of these ECG abnormalities was evaluated on Acute complete blockage of the culprit LCX (OR 3.871, 95% CI 1.820-8.231). T-wave imbalance (OR 3.871; 95% CI 1.820-8.231) and STV5 + STV6 ≥ 2.5 mm (OR 2.595; 95% CI 1.297-5.192) were independent predictors of acute complete occlusion of the culprit LCX in NSTEMI patients.
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