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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container_title European heart journal. Quality of care & clinical outcomes
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creator 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
description 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 
doi_str_mv 10.1093/ehjqcco/qcae003
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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 (&gt;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 &lt; 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P &lt; 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 &lt; 0.0001, STEMI: 1.55 [1.24–1.94], P &lt; 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. Graphical Abstract Graphical Abstract</description><identifier>ISSN: 2058-5225</identifier><identifier>ISSN: 2058-1742</identifier><identifier>EISSN: 2058-1742</identifier><identifier>DOI: 10.1093/ehjqcco/qcae003</identifier><identifier>PMID: 38192031</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>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</subject><ispartof>European heart journal. Quality of care &amp; clinical outcomes, 2024-08, Vol.10 (5), p.402-410</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c290t-6b2b71c75c53ea7249a29a0934aa4fac86ba7e3e117d4604a5591aed4db290933</citedby><cites>FETCH-LOGICAL-c290t-6b2b71c75c53ea7249a29a0934aa4fac86ba7e3e117d4604a5591aed4db290933</cites><orcidid>0000-0001-7898-3906 ; 0000-0003-2336-7991 ; 0000-0002-7350-1477 ; 0000-0002-4546-0479 ; 0000-0001-8001-0265</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38192031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abusharekh, Mohammed</creatorcontrib><creatorcontrib>Kampf, Jürgen</creatorcontrib><creatorcontrib>Dykun, Iryna</creatorcontrib><creatorcontrib>Souri, Kashif</creatorcontrib><creatorcontrib>Backmann, Viktoria</creatorcontrib><creatorcontrib>Al-Rashid, Fadi</creatorcontrib><creatorcontrib>Jánosi, Rolf Alexander</creatorcontrib><creatorcontrib>Totzeck, Matthias</creatorcontrib><creatorcontrib>Lawo, Thomas</creatorcontrib><creatorcontrib>Rassaf, Tienush</creatorcontrib><creatorcontrib>Mahabadi, Amir Abbas</creatorcontrib><title>Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality</title><title>European heart journal. Quality of care &amp; clinical outcomes</title><addtitle>Eur Heart J Qual Care Clin Outcomes</addtitle><description>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 (&gt;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 &lt; 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P &lt; 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 &lt; 0.0001, STEMI: 1.55 [1.24–1.94], P &lt; 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. Graphical Abstract Graphical Abstract</description><subject>Aged</subject><subject>Cause of Death - trends</subject><subject>Coronary Angiography</subject><subject>Coronary Occlusion - complications</subject><subject>Coronary Occlusion - diagnosis</subject><subject>Coronary Occlusion - mortality</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Non-ST Elevated Myocardial Infarction - mortality</subject><subject>Percutaneous Coronary Intervention</subject><subject>Retrospective Studies</subject><subject>ST Elevation Myocardial Infarction - mortality</subject><subject>ST Elevation Myocardial Infarction - surgery</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>2058-5225</issn><issn>2058-1742</issn><issn>2058-1742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkc1r3EAMxYfS0oQ059zKQC-l4Ox8eOyd3kJIm0IghyZnI8vaxsvYszsfCfnvO-26PeSSkx7op4ekx9iZFOdSWL2ih-0e0a_2CCSEfsOOlTDrSra1ertoo5Q5YqcxboUQstGtlM17dqTX0iqh5TF7usCciKMPfobwzD2iy3H0M38a0wN_jOd_hc-J_7zj5OgRUul-5eO0A0y8gLvgkYYcwPGCoZ8ocpgH7vz8q0oUJg7OVQg5Ep98SODG9PyBvduAi3S61BN2_-3q7vK6urn9_uPy4qZCZUWqml71rcTWoNEEraotKAvl-Bqg3gCumx5a0iRlO9SNqMEYK4GGeujLvNX6hH0--JYt95li6qYxIjkHM_kcO2WlMqqprSnopxfo1ucwl-06LazVqpWmKdTqQGHwMQbadLswTuV1nRTdn1i6JZZuiaVMfFx8cz_R8J__F0IBvhwAn3evuv0GNDGamQ</recordid><startdate>20240808</startdate><enddate>20240808</enddate><creator>Abusharekh, Mohammed</creator><creator>Kampf, Jürgen</creator><creator>Dykun, Iryna</creator><creator>Souri, Kashif</creator><creator>Backmann, Viktoria</creator><creator>Al-Rashid, Fadi</creator><creator>Jánosi, Rolf Alexander</creator><creator>Totzeck, Matthias</creator><creator>Lawo, Thomas</creator><creator>Rassaf, Tienush</creator><creator>Mahabadi, Amir Abbas</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7898-3906</orcidid><orcidid>https://orcid.org/0000-0003-2336-7991</orcidid><orcidid>https://orcid.org/0000-0002-7350-1477</orcidid><orcidid>https://orcid.org/0000-0002-4546-0479</orcidid><orcidid>https://orcid.org/0000-0001-8001-0265</orcidid></search><sort><creationdate>20240808</creationdate><title>Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c290t-6b2b71c75c53ea7249a29a0934aa4fac86ba7e3e117d4604a5591aed4db290933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Cause of Death - trends</topic><topic>Coronary Angiography</topic><topic>Coronary Occlusion - complications</topic><topic>Coronary Occlusion - diagnosis</topic><topic>Coronary Occlusion - mortality</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Non-ST Elevated Myocardial Infarction - mortality</topic><topic>Percutaneous Coronary Intervention</topic><topic>Retrospective Studies</topic><topic>ST Elevation Myocardial Infarction - mortality</topic><topic>ST Elevation Myocardial Infarction - surgery</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abusharekh, Mohammed</creatorcontrib><creatorcontrib>Kampf, Jürgen</creatorcontrib><creatorcontrib>Dykun, Iryna</creatorcontrib><creatorcontrib>Souri, Kashif</creatorcontrib><creatorcontrib>Backmann, Viktoria</creatorcontrib><creatorcontrib>Al-Rashid, Fadi</creatorcontrib><creatorcontrib>Jánosi, Rolf Alexander</creatorcontrib><creatorcontrib>Totzeck, Matthias</creatorcontrib><creatorcontrib>Lawo, Thomas</creatorcontrib><creatorcontrib>Rassaf, Tienush</creatorcontrib><creatorcontrib>Mahabadi, Amir Abbas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Quality of care &amp; clinical outcomes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abusharekh, Mohammed</au><au>Kampf, Jürgen</au><au>Dykun, Iryna</au><au>Souri, Kashif</au><au>Backmann, Viktoria</au><au>Al-Rashid, Fadi</au><au>Jánosi, Rolf Alexander</au><au>Totzeck, Matthias</au><au>Lawo, Thomas</au><au>Rassaf, Tienush</au><au>Mahabadi, Amir Abbas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality</atitle><jtitle>European heart journal. Quality of care &amp; clinical outcomes</jtitle><addtitle>Eur Heart J Qual Care Clin Outcomes</addtitle><date>2024-08-08</date><risdate>2024</risdate><volume>10</volume><issue>5</issue><spage>402</spage><epage>410</epage><pages>402-410</pages><issn>2058-5225</issn><issn>2058-1742</issn><eissn>2058-1742</eissn><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 (&gt;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 &lt; 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P &lt; 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 &lt; 0.0001, STEMI: 1.55 [1.24–1.94], P &lt; 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. Graphical Abstract Graphical Abstract</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>38192031</pmid><doi>10.1093/ehjqcco/qcae003</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7898-3906</orcidid><orcidid>https://orcid.org/0000-0003-2336-7991</orcidid><orcidid>https://orcid.org/0000-0002-7350-1477</orcidid><orcidid>https://orcid.org/0000-0002-4546-0479</orcidid><orcidid>https://orcid.org/0000-0001-8001-0265</orcidid></addata></record>
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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
title Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality
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