Clinical Predictors of Acute Total Occlusion of Culprit Vessels in Patients with Non-ST Segment Elevation Myocardial Infarction

Abstract

Background: Acute total occlusion of culprit vessel in patients with non–ST-segment elevation myocardial infarction (NSTEMI) accounts for third of these cases, who are at higher risk of mortality and morbidity. Earlier interventions in such patients may improve their prognosis. However, there are no specific clinical predictors that can identify this group. Objectives: We attempted to identify acute total occlusion of culprit vessel in patients with NSTEMI from varied clinical parameters such as symptoms, electrocardiograms, conventional echocardiograms and cardiac biomarkers. Methods: It was a single centre retrospective study of all NSTEMI patients with acute total occlusion over 9 years from January 2010 to December 2018. Results: From angiographic data 1700 out of 10800 (15.74%) patients were identified to have NSTEMI. 458 out of 1700 (27%) had acute total occlusion of culprit vessel. Mean time from onset of chest pain to coronary intervention was 33 ± 26 hours longer than STEMI cases (< 90 min). Younger age, BMI>25, higher peak troponin and CPK, ongoing chest pain, dynamic/new ECG changes were all highly significant in patients with acute total occlusion of culprit vessel by univariate analysis. Whereas, ongoing chest pain (p value 0.001, OR 6.1 and CI 3.6 to 10.3), new/dynamic ECG changes (p value: 0.006, OR 2.2, CI 1.3 to 6.7), younger age (p .015) and higher peak cardiac troponin (p .035) are predictive of ATO of culprit vessel. Conclusion: Ongoing chest pain, new/dynamic ECG changes, younger age and higher peak troponin levels may help identify patients with NSTEMI with occluded culprit vessel and expedite their appropriate timely interventions, who are disadvantaged by delayed identification and management as in our study.