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http://hdl.handle.net/11054/1828
Title: | Totally occluded culprit coronary artery in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention. |
Author: | Fernando, H. Duffy, S. Low, A. Dinh, D. Adrianopoulos, N. Sharma, Anand Karlheinz, P. Stub, D. Leong, Kai'En Ajani, A. Clark, D. Freeman, M. Sebastian, M. Brennan, A. Selkrig, L. Reid, C. Kaye, D. Oqueli, Ernesto |
Issue Date: | 2021 |
Publication Title: | The American Journal of Cardiology |
Volume: | 56 |
Start Page: | 52 |
End Page: | 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. |
URI: | http://hdl.handle.net/11054/1828 |
DOI: | https://doi.org/10.1016/j.amjcard.2021.06.043 |
Internal ID Number: | 01788 |
Health Subject: | PCI PERCUTANEOUS CORONARY INTERVENTION STEMI MYOCARDIAL INFARCTION |
Type: | Journal Article Article |
Appears in Collections: | Research Output |
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