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Title: Prevalence, predictors and outcomes of patients with totally occluded culprit artery in non-ST-elevation myocardial infarction.
Author: Fernando, H.
Adrianopoulos, Nick
Sharma, Anand
Leong, Kai'en
Ajani, A.
Clark, D.
Freeman, M.
Sebastian, M.
Brennan, A.
Selkrig, L.
Reid, C.
Kaye, D.
Duffy, S.
Oqueli, Ernesto
Issue Date: 2018
Conference Name: 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 12th Annual Australia and New Zealand Endovascular Therapies Meeting.
Conference Date: August 2-5th
Conference Place: Brisbane, Queensland
Abstract: 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. Methods: Data were analysed from patients with NSTEMI and who underwent single-vessel percutaneous coronary intervention (PCI) within the Melbourne Interventional Group between 2005 and 2017. Those with occluded culprit vessels were compared to non-occluded culprit vessels. The primary endpoint was 30-day major adverse coronary events (MACE). Secondary endpoints included 12-month MACE and National Death Index-linked mortality. Secondary analysis compared outcomes between STEMI and NSTEMI patients with occluded arteries. Results: A total of 6,829 patients with NSTEMI had single-vessel PCI, of which 954 (14%) had occluded culprit arteries. Most occluded culprit arteries were non-left anterior descending (LAD) (right coronary artery (RCA) 39% vs circumflex 33% vs LAD 26%, p < 0.001). Cardiogenic shock and left ventricular dysfunction were higher in the occluded artery group, but non-occlusion patients had higher baseline comorbidities. Thirty-day MACE was higher in the occluded artery group (6.7% vs 3.8%, p < 0.001). Multivariate Cox proportional hazards regression identified occluded arteries as an independent predictor of 30-day MACE (HR = 1.93, 95% CI 1.4–2.6). However, long-term outcomes in the NSTEMI occluded artery group were better than the overall NSTEMI cohort. The STEMI cohort had higher 30-day all-cause mortality (5.2% vs 1.3%, p < 0.001) and MACE (8.7% vs 6.7%, p = 0.046) than the NSTEMI occluded artery group. Conclusion: Whilst NSTEMI patients with occluded culprit arteries represented a more unstable subgroup early on, long-term outcomes appeared to be more dependent on baseline comorbidities. Despite potential delays in emergent PCI, they represented a lower risk group than STEMI patients.
Internal ID Number: 01243
Type: Conference
Appears in Collections:Research Output

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