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

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...

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Published in:European heart journal. Quality of care & clinical outcomes 2024-08, Vol.10 (5), p.402-410
Main Authors: Abusharekh, Mohammed, Kampf, Jürgen, Dykun, Iryna, Souri, Kashif, Backmann, Viktoria, Al-Rashid, Fadi, Jánosi, Rolf Alexander, Totzeck, Matthias, Lawo, Thomas, Rassaf, Tienush, Mahabadi, Amir Abbas
Format: Article
Language:English
Subjects:
Aged
Cause of Death - trends
Coronary Angiography
Coronary Occlusion - complications
Coronary Occlusion - diagnosis
Coronary Occlusion - mortality
Electrocardiography
Female
Follow-Up Studies
Heart attacks
Humans
Male
Middle Aged
Mortality
Non-ST Elevated Myocardial Infarction - mortality
Percutaneous Coronary Intervention
Retrospective Studies
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - surgery
Survival Rate - trends
Time Factors
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Summary: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 
ISSN:2058-5225
2058-1742
2058-1742
DOI:10.1093/ehjqcco/qcae003