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Title: Totally Occluded Culprit Coronary Artery in Patients with Non-ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.
Austin Authors: Fernando, Himawan;Duffy, Stephen J;Low, Ashlea;Dinh, Diem;Adrianopoulos, Nick;Sharma, Anand;Peter, Karlheinz;Stub, Dion;Leong, Kai'En;Ajani, Andrew;Clark, David J ;Freeman, Melanie;Sebastian, Martin;Brennan, Angela;Selkrig, Laura;Reid, Christopher M;Kaye, David;Oqueli, Ernesto
Affiliation: School of Public Health, Curtin University, Perth, Western Australia, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
Department of Cardiology, Alfred Hospital, Melbourne, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Baker Heart and Diabetes Institute, Melbourne, Australia
Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
Central Clinical School, Monash University, Melbourne, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Issue Date: 1-Oct-2021 2021-08-03
Publication information: The American Journal of Cardiology 2021; 156: 52-57
Abstract: The short- and long-term implications of identifying totally occluded culprit coronary arteries (TOCCA) in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) have not been well studied. This study compares clinical characteristics, short- and long-term outcomes of patients with NSTEMI identified with TOCCA to that of patients with non-TOCCA undergoing percutaneous coronary intervention (PCI). We analyzed data from patients with NSTEMI undergoing single-vessel PCI within the Melbourne Interventional Group multi-center registry between 2005 and 2017. Those with TOCCA were compared to those with non-TOCCA. The primary endpoint was 30-day major adverse cardiac events (MACE). Secondary endpoints included 12-month MACE and long-term mortality. A total of 6,829 patients with NSTEMI had single-vessel PCI of which 954 (14%) had TOCCA. Most TOCCA were non-left anterior descending (right coronary artery 39% versus circumflex 33% versus left anterior descending 26%; p <0.001). Cardiogenic shock and left ventricular dysfunction were higher in the TOCCA group, but non-TOCCA patients had more baseline comorbidities. Thirty-day MACE was higher in the TOCCA group (6.7% versus 3.8%; p <0.001). Long-term mortality with an average follow-up of 4.9 years was higher in the non-TOCCA group (12% versus 18%, p <0.01). Multivariable Cox-proportional hazards regression identified TOCCA as an independent predictor of 30-day MACE (HR = 1.93; 95%CI: 1.4-2.6), but not long-term mortality, which was predicted by baseline comorbidities. In conclusion, while patients with NSTEMI with TOCCA undergoing PCI represent a more unstable subgroup early on, long-term outcomes appear more dependent on baseline comorbidities.
DOI: 10.1016/j.amjcard.2021.06.043
Journal: The American Journal of Cardiology
PubMed URL: 34362552
Type: Journal Article
Subjects: Myocardial Infarction
Percutaneous Coronary Intervention
Appears in Collections:Journal articles

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