Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?

<i>Background and Objectives:</i> Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain uncle...

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Autores principales:	Irmina Morawska, Rafał Niemiec, Maria Stec, Karolina Wrona, Paweł Bańka, Andrzej Swinarew, Maciej Wybraniec, Katarzyna Mizia-Stec
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	non-ST-segment elevation myocardial infarction total occlusion infarct-related artery clinical predictors Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/2d4498ede87f4c499dd584b888c424d1
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spelling	oai:doaj.org-article:2d4498ede87f4c499dd584b888c424d12021-11-25T18:18:29ZTotal Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?10.3390/medicina571111961648-91441010-660Xhttps://doaj.org/article/2d4498ede87f4c499dd584b888c424d12021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1196https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objectives:</i> Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain unclear. <i>Aim:</i> The study aimed to assess the incidence and predictors of TO of IRA in patients with NSTEMI, and its clinical significance. <i>Material and Methods:</i> The study was a single-center retrospective cohort analysis of 399 consecutive patients with NSTEMI (293 male, mean age: 71 ± 10.1 years) undergoing percutaneous coronary intervention. The study population was categorized into patients with TO and non-TO of IRA on coronary angiography. In-hospital and one-year mortality were analyzed. <i>Results:</i> TO of IRA in the NSTEMI population occurred in 138 (34.6%) patients. Multivariate analysis identified the following independent predictors of TO of IRA: left ventricular ejection fraction (odds ratio (OR) 0.949, <i>p</i> < 0.001); family history of coronary artery disease (CAD) (OR 2.652, <i>p</i> < 0.001); and high-density lipoprotein (HDL) level (OR 0.972, <i>p</i> = 0.002). In-hospital and one-year mortality were significantly higher in the TO group than the non-TO group (2.8% vs. 1.1%, <i>p</i> = 0.007 and 18.1% vs. 6.5%, <i>p</i> < 0.001, respectively). The independent predictors of in-hospital mortality were: left ventricular ejection fraction (LVEF) at admission (OR 0.768, <i>p</i> = 0.004); and TO of IRA (OR 1.863, <i>p</i> = 0.005). <i>Conclusions:</i> In the population of patients with NSTEMI, TO of IRA represents a considerably frequent phenomenon, and corresponds with impaired outcomes. Therefore, the utmost caution should be paid to prevent delay of coronary angiography in NSTEMI patients with impaired left ventricular systolic function, metabolic disturbances, and a family history of CAD, who are at increased risk of TO of IRA.Irmina MorawskaRafał NiemiecMaria StecKarolina WronaPaweł BańkaAndrzej SwinarewMaciej WybraniecKatarzyna Mizia-StecMDPI AGarticlenon-ST-segment elevation myocardial infarctiontotal occlusioninfarct-related arteryclinical predictorsMedicine (General)R5-920ENMedicina, Vol 57, Iss 1196, p 1196 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	non-ST-segment elevation myocardial infarction total occlusion infarct-related artery clinical predictors Medicine (General) R5-920
spellingShingle	non-ST-segment elevation myocardial infarction total occlusion infarct-related artery clinical predictors Medicine (General) R5-920 Irmina Morawska Rafał Niemiec Maria Stec Karolina Wrona Paweł Bańka Andrzej Swinarew Maciej Wybraniec Katarzyna Mizia-Stec Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
description	<i>Background and Objectives:</i> Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain unclear. <i>Aim:</i> The study aimed to assess the incidence and predictors of TO of IRA in patients with NSTEMI, and its clinical significance. <i>Material and Methods:</i> The study was a single-center retrospective cohort analysis of 399 consecutive patients with NSTEMI (293 male, mean age: 71 ± 10.1 years) undergoing percutaneous coronary intervention. The study population was categorized into patients with TO and non-TO of IRA on coronary angiography. In-hospital and one-year mortality were analyzed. <i>Results:</i> TO of IRA in the NSTEMI population occurred in 138 (34.6%) patients. Multivariate analysis identified the following independent predictors of TO of IRA: left ventricular ejection fraction (odds ratio (OR) 0.949, <i>p</i> < 0.001); family history of coronary artery disease (CAD) (OR 2.652, <i>p</i> < 0.001); and high-density lipoprotein (HDL) level (OR 0.972, <i>p</i> = 0.002). In-hospital and one-year mortality were significantly higher in the TO group than the non-TO group (2.8% vs. 1.1%, <i>p</i> = 0.007 and 18.1% vs. 6.5%, <i>p</i> < 0.001, respectively). The independent predictors of in-hospital mortality were: left ventricular ejection fraction (LVEF) at admission (OR 0.768, <i>p</i> = 0.004); and TO of IRA (OR 1.863, <i>p</i> = 0.005). <i>Conclusions:</i> In the population of patients with NSTEMI, TO of IRA represents a considerably frequent phenomenon, and corresponds with impaired outcomes. Therefore, the utmost caution should be paid to prevent delay of coronary angiography in NSTEMI patients with impaired left ventricular systolic function, metabolic disturbances, and a family history of CAD, who are at increased risk of TO of IRA.
format	article
author	Irmina Morawska Rafał Niemiec Maria Stec Karolina Wrona Paweł Bańka Andrzej Swinarew Maciej Wybraniec Katarzyna Mizia-Stec
author_facet	Irmina Morawska Rafał Niemiec Maria Stec Karolina Wrona Paweł Bańka Andrzej Swinarew Maciej Wybraniec Katarzyna Mizia-Stec
author_sort	Irmina Morawska
title	Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
title_short	Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
title_full	Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
title_fullStr	Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
title_full_unstemmed	Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?
title_sort	total occlusion of the infarct-related artery in non-st-elevation myocardial infarction (nstemi)—how can we identify these patients?
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2d4498ede87f4c499dd584b888c424d1
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Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?

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