Total occlusion of the culprit artery in NSTEMI patients was associated with a higher 2-year rate of the primary composite endpoint compared to non-occluded arteries (25% vs. 19.1%; P=0.003).
Observational (n=3,272)
Yes
Does total occlusion of the culprit artery (TOCA) increase the risk of adverse cardiovascular events in patients presenting with NSTEMI?
In patients with NSTEMI, total occlusion of the culprit artery is present in about 15% of cases and is associated with a significantly higher risk of MACCE, fatal arrhythmias, and mechanical complications.
Odds Ratio: 1.379
Absolute Event Rate: 25% vs 19.1%
p-value: p=0.003
BACKGROUND: A subset ofpatients found to have total occlusion of the culprit artery (TOCA), present with non-ST-segment elevation myocardial infarction (NSTEMI) and elevated biomarkers. The aim of this study is to assess the effect of the TOCA in patients presenting with NSTEMI. METHODS: This multicenter observational study was retrospectively conducted between 2015 and 2019. Thrombolysis in myocardial infarction (TIMI) flow grades 0-1 was defined as the TOCA. The primary end point included a combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke. RESULTS: Of 3272 patients, TIMI 0-1 flow in the culprit artery was present in 488 (14.9%) patients. TOCA was more likely to be of thrombotic origin (54.1% vs. 10.3%; P < 0.001) and visible collaterals (22.5% vs. 4.4%; P < 0.001). The rates of 30-day (14.3% vs. 7.2%; P < 0.001) and 2-year (25% vs. 19.1%; P = 0.003) primary end points were significantly higher in TOCA patients. Fatal arrhythmias were remarkably higher at 30-day (8.6% vs. 4%; P < 0.001) and 2-year (9% vs. 5.2%; P = 0.001) follow-ups. Mechanical complications were also higher in patients with TOCA at 30 days (0.8% vs. 0.2%; P = 0.013). Moreover, TOCA (OR, 1.379; P = 0.001) was one of the independent predictors of MACCE in NSTEMI patients. CONCLUSION: The current data suggest that patients with TOCA in the context of NSTEMI are at higher risk of MACCE, fatal arrhythmias, and mechanical complications.
Güner et al. (Fri,) conducted a observational in non-ST-segment elevation myocardial infarction (NSTEMI) (n=3,272). Total occlusion of the culprit artery (TOCA) vs. Non-totally occluded culprit artery was evaluated on combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke (OR 1.379, p=0.003). Total occlusion of the culprit artery in NSTEMI patients was associated with a higher 2-year rate of the primary composite endpoint compared to non-occluded arteries (25% vs. 19.1%; P=0.003).