Occluded Culprit Artery Research Articles

Abstract 15133: Topic Models Using Notes From Electronic Medical Records Can Classify Non ST Elevation Myocardial Infarction Patients Based on the Presence of an Occluded Culprit Artery

Introduction: Approximately 33% of patients with a Non-ST-Elevation Myocardial Infarction (NSTEMI) have an occluded culprit artery which doubles their odds of adverse outcomes. Earlier identification of NSTEMI patients with occluded culprit artery may reduce their odds of adverse outcomes. Notes from the electronic health record (EHR) are rich sources of text data about signs and symptoms. Organizing text data into topics may help providers identify patients with NSTEMI and an occluded culprit artery sooner. Latent Dirichlet Allocation uses a deep-learning network to generate topics that can classify patients. Methods: Notes transcribed during the first 72 hours of hospitalization were extracted from the EHR among NSTEMI patients who presented to a medical center between 2015-2020. The data was preprocessed by removing punctuation, numbers, and stop words. We decided 5 topics based on computed coherence value. Two authors determined whether the first 100 terms were associated with an occluded artery. Analyses were completed in R using packages topicmodels and tidyverse . Results: We examined 45,025 notes from 2,223 patients (age=69 + 14 years old; 57% n=1267 male; 83% n=1,845 White) who experienced 2,685 hospitalizations (17%, n=462 NSTEMI re-hospitalizations). In Topic 1, 70% of the terms were associated with an occluded culprit artery including “chest pain” and “troponin”. In contrast, in Topic 5, 90% of terms were not associated with an occluded culprit artery such as “edema” and “pulmonary”. Figure 1 shows the frequency of terms associated with an occluded artery per topic. Conclusions: Topic 1 is most associated with an occluded culprit artery. Topic 5 is the least associated with an occluded culprit artery, instead associated with heart failure. Our results demonstrate it is feasible to develop topics to differentiate NSTEMI with and without an occluded culprit artery. Future research aims to identify patterns between signs and symptoms within topics.

Clinical variables associated with no-reflow after percutaneous coronary intervention in ST-segment elevation myocardial infarction: Secondary analysis of the PERSTEMI I and II study

To determine the clinical factors associated to no-reflow after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) in Peru. Case - control retrospective study, derived from the PERSTEMI (Peruvian Registry of ST-elevation myocardial infarction) I and II study. Cases (group 1) were those patients who presented no-reflow after PCI, defined by a TIMI flow < 3, and controls (group 2) were those with a TIMI 3 flow after the intervention. Clinical and angiographic variables were compared between both groups, and a multivariate analysis was performed looking for associated factors to no-reflow. We included 75 cases and 304 controls. The incidence of no-reflow was 19.8%. There was a higher frequency of no-reflow in patients with primary PCI compared to the pharmacoinvasive strategy, in patients with one-vessel disease and in those with TIMI 0 before PCI. In-hospital mortality and heart failure were higher in patients with no-reflow (21.3% vs. 2.9% and 45.3% vs. 16.5, respectively; p<0.001). After the multivariate analysis, the ischemia time > 12 hours, Killip Kimball (KK) > I, TIMI 0 before PCI, and one-vessel disease were the factors significantly associated with no-reflow after PCI. The ischemia time greater than 12 hours, the highest KK score, the presence of an occluded culprit artery (TIMI 0) before PCI and an one-vessel disease, were factors independently associated to no-reflow in patients with STEMI in Peru.

Laboratory markers at admission to predict the presence of totally occluded culprit artery in NSTEMI.

A significant proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) have a totally occluded culprit artery (OCA). If these patients do not meet very high-risk criteria, they may be deprived of an immediate invasive strategy. Therefore, there is a need for markers that can predict OCA in patients with NSTEMI. A total of 357 consecutive patients with NSTEMI but without very high-risk criteria were included in this retrospective study. Two groups were formed: NSTEMI with OCA (n = 106) and NSTEMI with patent culprit artery (PCA) (n = 251). Complete blood count (CBC) and serum biochemical parameters obtained immediately at admission were compared between the groups. Receiver operating characteristic (ROC) analysis to predict the presence of OCA was performed for the parameters that were significantly different between the groups, and an area under the curve (AUC) > 0.7 was considered to suggest acceptable discrimination. Neutrophil count [8.13 (2.82-27.88) × 103/µL vs 5.59 (1.85-19.71) × 103/µL, P < .001] and aspartate aminotransferase (AST) level [45 (12-405) U/L vs 25 (5-143) U/L, P < .001] were significantly higher in patients with OCA. The AUC was 0.750 for neutrophil count and 0.731 for AST level. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of elevated neutrophil and/or AST levels for the presence of OCA were 77.4%, 70.1%, 52.2%, and 88.0%, respectively. More strikingly, the specificity was 95.2% in the presence of both neutrophil and AST elevation. Elevated neutrophil and/or AST levels at admission were strongly associated with the presence of OCA in patients with NSTEMI.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome

Abstract Background Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. Purpose The aim of this study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. Methods We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Results Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p&amp;lt;0.001), significantly more collaterals (p&amp;lt;0.001), and significantly more LCX and RCA as the culprit vessel (p&amp;lt;0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). Conclusion 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia. Funding Acknowledgement Type of funding sources: None.

Non-ST Elevation Myocardial Infarction With Occluded Culprit Artery: A Continuum of Mortality Risk Across the Spectrum of Acute Myocardial Infarction.

Non-ST segment elevation myocardial infarction (NSTEMI) patients presenting with occluded culprit artery (OCA) may be at higher risk for worse outcomes. We sought to compare in-hospital (IH) mortality between patients presenting with NSTEMI with and without OCA, and ST-segment elevation myocardial infarction (STEMI). This retrospective analysis studied 14,037 patients enrolled in the Portuguese National Registry of Acute Coronary Syndromes. Three groups were defined: (A) STEMI (n = 8616); (B) OCA-NSTEMI (n = 1309); and (C) non-OCA NSTEMI (n = 4112). Baseline characteristics, therapeutic strategies, and outcomes were compared. Multivariate analysis was performed to assess the risk of IH all-cause mortality across the prespecified groups. Twenty-four percent of NSTEMI patients presented with OCA. The left circumflex artery was more frequently the culprit artery in group B (12.4% A vs 34.5% B vs 26.0% C; P<.001) and this group was also less likely to receive percutaneous revascularization (95.2% A vs 69.7% B vs 83.2% C; P<.001). The incidence of left ventricular systolic dysfunction was higher in group A and lower in group C (19.9% A vs 12.2% B vs 8.1% C; P<.001). The adjusted risk of IH mortality was significantly higher in group A when compared with group B (3.9% A vs 1.8% B; odds ratio, 2.34; 95% confidence interval, 1.34-4.07; P<.01) and in group B when compared with group C (1.8% B vs 0.9% C; odds ratio, 2.25; 95% confidence interval, 1.17-4.35; P=.02). OCA-NSTEMI patients had worse IH outcomes than non-OCA NSTEMI patients and better IH outcomes than STEMI patients, suggesting the existence of a continuum of increased risk of IH mortality across these groups.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome

BackgroundSignificance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients.ResultsWe collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24).Conclusion22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

COMPARISON OF MANUAL THROMBUS ASPIRATION WITH DIRECT STENTING IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND TOTALLY OCCLUDED CULPRIT ARTERIES

The aimof this study was to evaluate the efficacy and safety of the manual thrombus aspiration in comparison with direct stenting in patients with ST-segment elevation myocardial infarction (STEMI) and totally occluded culprit arteries.Material and Methods. Data were collected from the hospital database, which contained information about 1297 patients with STEMI who were admitted to the coronary care unit and underwent primary percutaneous coronary interventions. A total of 227 patients with totally occluded culprit arteries and partially or completely restored blood flow after wiring were included in the analysis. Altogether 25 patients after manual thrombus aspiration were compared with 202 patients after direct stenting. The groups were comparable by gender and age, and by the main clinical and angiographic characteristics.Results.There were no differences in in-hospital outcomes. In the thrombus aspiration group, the rate of no-reflow phenomenon was higher insignificantly (8 vs 3.5%, р=0.259). There were no incidences of death and major adverse cardiac events in the thrombus aspiration group. No cases of stent thrombosis were registered in either of group.Conclusion. The manual thrombus aspiration strategy in comparison with direct stenting in patients with STEMI and totally occluded culprit artery was not associated with improved clinical and procedural in-hospital outcomes.

Clinical characteristics of occluded culprit arteries and collaterals in patients with non-ST-segment elevation myocardial infarction and impact on clinical outcomes.

The presence of an occluded culprit artery or collaterals in non-ST-segment elevation myocardial infarction (NSTEMI) is relatively common; however, limited data are available regarding their clinical significance. The aim of the current study was to determine the clinical characteristics of occluded culprit arteries and coronary collaterals in patients with NSTEMI and their impact on patient outcomes. A total of 345 patients diagnosed with NSTEMI via coronary angiography between February 2006 and May 2013 were evaluated in the present study. Patient demographics, procedural characteristics and clinical outcomes of patients were analyzed according to the presence of an occluded culprit artery and coronary collaterals. A total of 78 (22.6%) and 166 patients (48.1%) exhibited an occluded artery and coronary collaterals, respectively. The left anterior descending artery is a more common location of culprit arteries in patients with NSTEMI with patent artery (NSTEMIPA) and distal parts of the artery are more common location of culprit arteries in patients with NSTEMI with occluded arteries (NSTEMIOA). Patients with NSTEMIOA exhibited higher peak creatine kinase-MB (CKMB) and troponin-I levels compared with patients that had NSTEMIPA. The presence of coronary collaterals is associated with a lower mean left ventricular ejection fraction, higher regional wall motion score index and extensive coronary artery disease. However, the clinical outcomes of patients with collaterals did not differ, irrespective of the presence of an occluded culprit artery or coronary collaterals. In the current study, ~25% of patients with NSTEMI had an occluded culprit coronary artery whereas 50% of patients with NSTEMI had coronary collaterals. The presence of an occluded artery and/or coronary collaterals did not affect clinical outcomes. Further studies are required to evaluate the long-term prognostic impact of an occluded artery and collaterals.

Percutaneous Coronary Interventions in Patients with ST-segment Elevation Myocardial Infarction and Totally Occluded Culprit Artery after Pre-hospital Thrombolysis

Percutaneous Coronary Interventions in Patients with ST-segment Elevation Myocardial Infarction and Totally Occluded Culprit Artery after Pre-hospital Thrombolysis

Area at risk and collateral circulation in a first acute myocardial infarction with occluded culprit artery. STEMI vs non-STEMI patients

BackgroundIt is unclear why among patients with first acute myocardial infarction and an occluded culprit artery only some present ST segment elevation. In fact, there is no study that compares the angiographic area at risk and the collateral circulation in first NSTEMI vs STEMI patients. Methods and results205 patients admitted for myocardial infarction with occluded culprit artery were included, 132 STEMI and 73 NSTEMI. Demographic data, the area at risk determined by the BARI score and collateral supply by the Rentrop score from the 2 groups were compared. NSTEMI patients showed lower peak Tn I than STEMI in the overall group but also in the 3 subsets with different culprit arteries (p < .001). They also presented a higher rate of left circumflex coronary artery (CFX) as culprit artery (52% vs 14%, p < .001), smaller BARI score area of the culprit artery (5.4 vs 7.6, p < .001), and higher frequency of well-developed collaterals (Rentrop score ≥ 2, 1.82 vs 0.41, p < .001). The latter was also higher in each of the 3 different culprit arteries (p = .002–<0.001) Among 38 NSTEMI patients with CFX occlusion, 20 with ≥1 mm ST depression in V2 to V4 (possible posterior infarction) showed a similar Rentrop score than the 18 with other ECG changes but lower Tn I peak (p = .012). ConclusionsIn first acute myocardial infarction with an occluded culprit artery NSTEMI patients – including those with possible posterior infarction – present smaller infarct size and higher collateral blood supply than STEMI patients in each of the 3 main culprit arteries.

Prevalence, Predictors and Outcomes of Patients With Totally Occluded Culprit Artery in Non-ST-Elevation Myocardial Infarction

Background: The implications of occluded culprit arteries in non-ST-elevation myocardial infarction (NSTEMI) patients require further study. This study sought to compare their outcomes with other NSTEMI and STEMI patients.

Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study.

BackgroundSeveral studies and meta-analyses have shown that direct stenting (DS) may improve clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI). But in most cases, the thrombolysis in myocardial infarction (TIMI) flow remains ≤ 1 after wire placement. We used deflated balloon to facilitate DS in patients with totally occluded culprit arteries. The aim of this study was to evaluate the feasibility, safety and outcomes of this novel technique in patients with STEMI in real-world clinical practice.MethodsThis was a prospective, observational, single-center pilot study. From September 2016 to June 2018, 454 patients were enrolled in the study. DS was performed when the culprit vessel was visualized with at least TIMI flow grade 1. Patients with complete occlusion of the vessel after wire placement were subjected to deflated balloon-facilitated DS technique (DBDS technique) and DS was done wherever possible.ResultsDS was done in 74% (n = 336) of the patients and 26% (n = 118) patients received stenting after pre-dilatation (PD). DBDS technique to facilitate DS was successful in 68% patients (211/309). Final TIMI 3 flow was achieved more frequently in the DS group as compared to PD group (96.7% versus 92.3%, P = 0.04). The procedural complications were also significantly lower in DS group (0.6% versus 7.6%, P < 0.001). DS group had significantly lower procedure time (33 ± 19 min versus 41 ± 17 min, P < 0.001), fluoroscopy time (6.2 ± 3.4 min versus 7.8 ± 32 min, P < 0.001), required lesser contrast volume (112 ± 16 mL versus 123 ± 18 mL, P < 0.001) and had lower procedural cost (310 ± 45$ versus 402 ± 56$, P < 0.001). ST-segment resolution > 50% after percutaneous coronary intervention (PCI) were significantly higher in the DS group (85.7% versus 71.1%, P < 0.001). At 30 days, the major adverse cardiac event (MACE) rate was significantly lower in the DS group (2.4% versus 9.3%, P = 0.02), mainly driven by lower rates of target lesion revascularization (TLR) (0.9% versus 4.2%, P = 0.01).ConclusionThis cost-effective technique appears to be simple, feasible and safe and is associated with superior clinical outcomes. It helps in maximizing DS and could offer an alternative to PD and aspiration thrombectomy in total occlusion. However, larger studies with longer follow up are required before a wider application of this technique.

TCT-1 Direct Stenting Strategy is Associated with Improved Outcomes in Patients with Totally Occluded Culprit Arteries Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

TCT-1 Direct Stenting Strategy is Associated with Improved Outcomes in Patients with Totally Occluded Culprit Arteries Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis.

Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and all-cause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5%) patients had an occluded culprit artery with a predominant infero-lateral distribution (40% right coronary and 33% left circumflex artery). There was an increased risk of both MACE (short-term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26%; medium- to long-term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25%) and all-cause mortality (short-term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41%; medium to long-term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32%) with TO of the culprit artery. Our meta-analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.

Position of ST-deviation measurements relative to the J-point: Impact for ischemia detection

BackgroundThere is no consensus about the time instant relative to the J point where ST deviation has to be measured for detection of acute ischemia in the ECG. MethodsWe analyzed 53 ECGs, recorded preceding emergency catheterization of acute coronary syndrome patients with a completely occluded culprit artery (cases), and 88 control ECGs recorded in the cardiology outpatient clinic. ECG-amplitude measurements were made every 10 ms, between 20 ms before till 80 ms after the J point. STEMI-detection algorithms varied from the traditional STEMI criterion (elevations in at least two adjacent ECG leads), via the STEMI equivalent criterion (depressions in V2 and V3), to the most liberal STEMI-detection algorithm in which elevations as well as depressions in two adjacent leads were considered as signs of ischemia. ResultsDiagnostic accuracy was highest (93.6%) for the most liberal STEMI-detection algorithm at 10 ms after the J point; sensitivity was 94.3% and specificity was 93.2%. ConclusionThe results of our study suggest that STEMI detection close to the J point is optimal.

Dietary Nitrate and the Epidemiology of Cardiovascular Disease: Report From a National Heart, Lung, and Blood Institute Workshop.

In view of continuing unanswered questions regarding the geographical and demographic distribution of cardiovascular disease, and recent discoveries about the effects of dietary nitrate on cardiovascular physiology, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop to

Prediction of totally occluded culprit artery from presenting electrocardiogram in acute coronary syndrome

Background: Revascularization strategy in acute coronary syndrome is based on the ST segment deviation in the presenting ECG. ST segment elevation denotes total occlusion of culprit vessel and mandates early revascularization. Aim: To study the correlation of totally occluded coronary vessel with ST segment elevation in presenting 12 lead ECG. Material and Methods: The present study was conducted in 89 consecutive patients with chestpain and angiogram evidence of at least one totally occluded epicardial coronary vessel. Culprit artery prediction was attempted according to the available algorithms and correlated with the angiogram finding. Results: Out of 89 cases 47 patients had left anterior descending artery (LAD), 27 had right coronary artery (RCA) and 15 had left circumflex artery (LCX) as culprit vessel. All patients with total occlusion of LAD and RCA had ST segment elevation, while only 50% of patients with circumflex artery occlusions had classical ST segment elevation. Conclusion: In our study we found that half of total circumflex artery occlusions were classified as non-ST elevation acute coronary syndrome when using the current 12-lead ECG criteria. This emphasizes the need for the incorporation of routine posterior leads in cases of suspected acute coronary syndrome if classical ST elevation is not present in 12-lead ECG .Otherwise many patients with totally occluded culprit arteries may be denied, the revascularization procedures in their golden hour.

Comparison of model-based and expert-rule based electrocardiographic identification of the culprit artery in patients with acute coronary syndrome

Background and purposeCulprit coronary artery assessment in the triage ECG of patients with suspected acute coronary syndrome (ACS) is relevant a priori knowledge preceding percutaneous coronary intervention (PCI). We compared a model-based automated method (Olson method) with an expert-rule based method for the culprit artery assessment. MethodsIn each of the 53 patients who were admitted with the working diagnosis of suspected ACS, scheduled for emergent angiography with a view on revascularization as initial treatment and subsequently found to have an angiographically documented completely occluded culprit artery, culprit artery location was assessed in the preceding ECG by both the model-based Olson method and the expert-rule based method that considered either visual or computer-measured J-point amplitudes. ECG culprit artery estimations were compared with the angiographic culprit lesion locations. Proportions of correct classifications were compared by a Z test at the 5% significance level. ResultsThe Olson method performed slightly, but not significantly, better, when the expert-rule based method used visual assessment of J-point amplitudes (88.7% versus 81.1% correct; P=0.28). However, the Olson method performed significantly better when the expert-rule based method used computer-measured J-point amplitudes (88.7% versus 71.7% correct; P<0.05). ConclusionThe automated model-based Olson method performed at least at the level of expert cardiologists using a manual rule-based method.

Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression

Objectives To evaluate both angiographic and clinical outcomes in patients with acute coronary syndrome (ACS) presenting with isolated anterior ST-segment depression on 12-lead ECG. Background ACS is an umbrella term used to cover a spectrum of events caused by acute myocardial ischemia. Patients and methods The study included 50 consecutive patients with ACS. All patients had isolated ST depression in the anterior leads on admission ECG. Coronary angiography and assessment of cardiac biomarkers were performed at baseline. According to TIMI flow grade in the culprit artery and the result of cardiac markers, patients were subdivided into three groups: group I: TIMI flow grade 0/1 and positive markers, group II: thrombolysis in myocardial infarction (TIMI) flow grade 2/3 and positive markers, and group III: TIMI flow grade 2/3 and negative markers. In-hospital and 30-day outcome were reported. Results On the basis of coronary angiography findings and results of cardiac markers, 12 patients (24%) had totally occluded culprit artery plus positive markers (group I) and 10 patients (20%) had TIMI flow II/III plus subtotal occlusion in the culprit artery and positive markers (group II), whereas 28 patients (56%) patients had TIMI flow II/III and negative markers (group III). In-hospital and 30-day outcomes did not differ between groups. Conclusion Among patients with ACS presenting with isolated anterior ST-segment depression, about one-quarter had an occluded culprit artery and elevated cardiac markers.

Incidence and Impact of Totally Occluded Culprit Coronary Arteries in Patients Presenting With Non–ST-Segment Elevation Myocardial Infarction

The accuracy of the 12-lead electrocardiogram in detecting coronary artery occlusion is limited. We sought to determine the incidence, distribution, and outcomes of patients who have total occlusion of the culprit artery but present with non-ST-segment elevation myocardial infarction (NSTEMI). The randomized Acute Catheterization and Urgent Intervention Triage Strategy trial enrolled 13,819 patients presenting with non-ST-segment elevation acute coronary syndromes who underwent an early invasive strategy. The present study includes 1,319 patients with baseline biomarker elevation (NSTEMI) and no history of coronary artery bypass graft who underwent percutaneous coronary intervention of a single culprit vessel. We compared the baseline characteristics and outcomes according to whether the culprit vessel was occluded (baseline Thrombolysis In Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit artery was present in 262 of 1,319 (19.9%) patients. The incidence of coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI because of right coronary, left circumflex, and left anterior descending artery disease, respectively. Patients with an occluded culprit artery were more commonly men and had ST-segment deviation ≥1mm. One-year outcomes, including death (3.5% vs 3.0%, p= 0.68) and myocardial infarction (8.4% vs 9.6%, p= 0.47), did not differ significantly between patients with versus without occluded culprit arteries, respectively. In conclusion, the present study demonstrates that the culprit artery is totally occluded in approximately 1 in 5 patients presenting with NSTEMI and single-vessel disease; however, the presence of total occlusion in NSTEMI was not associated with an incremental hazard of death or reinfarction at 1year.