Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality

Author:

Abusharekh Mohammed1ORCID,Kampf Jürgen1,Dykun Iryna1ORCID,Souri Kashif2,Backmann Viktoria1,Al-Rashid Fadi1,Jánosi Rolf Alexander1,Totzeck Matthias1ORCID,Lawo Thomas2,Rassaf Tienush1ORCID,Mahabadi Amir Abbas1ORCID

Affiliation:

1. Department of Cardiology and Vascular Medicine, The West German Heart and Vascular Center Essen, University Hospital Essen , Hufeland Street 55, 45147 Essen , Germany

2. Department of Cardiology, The Elisabeth Hospital Recklinghausen , Röntgen Street 10, 45661 Recklinghausen , Germany

Abstract

Abstract Background Acute total occlusion (ATO) is diagnosed in a substantial proportion of patients with non-ST-elevation myocardial infarction (NSTEMI). We compared procedural outcomes and long-term mortality in patients with STEMI with NSTEMI with vs. without ATO. Methods and results We included patients with acute myocardial infarction (AMI) undergoing invasive coronary angiography between 2004 and 2019 at our centre. Acute total occlusion was defined as thrombolysis in myocardial infarction (TIMI) 0–1 flow in the infarct-related artery or TIMI 2–3 flow with highly elevated peak troponin (>100-folds the upper reference limit). Association between presentation and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. From 2269 AMI patients (mean age 66 ± 13.2 years, 74% male), 664 patients with STEMI and 1605 patients with NSTEMI (471 [29.3%] with ATO) were included. ATO(+)NSTEMI patients had a higher frequency of cardiogenic shock and no reflow than ATO(−)NSTEMI with similar rates compared with STEMI patients (cardiogenic shock: 2.76 vs. 0.27 vs. 2.86%, P < 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P < 0.0001, P = 0.54). ATO(+)NSTEMI and STEMI were associated with 60 and 55% increased incident mortality, respectively, as compared with ATO(−)NSTEMI (ATO(+)NSTEMI: 1.60 [1.27–2.02], P < 0.0001, STEMI: 1.55 [1.24–1.94], P < 0.0001). Likewise, left ventricular ejection fraction (48.5 ± 12.7 vs. 49.1±11 vs. 50.6 ± 11.8%, P = 0.5, P = 0.018) and global longitudinal strain (−15.2 ± –5.74 vs. −15.5 ± –4.84 vs. −16.3 ± –5.30%, P = 0.48, P = 0.016) in ATO(+)NSTEMI were comparable to STEMI but significantly worse than in ATO(−)NSTEMI. Conclusion Non-ST-elevation myocardial infarction patients with ATO have unfavourable procedural outcomes, resulting in increased long-term mortality, resembling STEMI. Our findings suggest that the occlusion perspective provides a more appropriate classification of AMI than differentiation into STEMI vs. NSTEMI.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Health Policy

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