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अमूर्त

Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients with Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

Sherif Ayad*, Tarek El Zawawy, Mohamed Loutfi, Ahmed Naguib, Ahmed El Amrawy

Background: Significance of totally occluded culprit coronary artery in patients presenting with Non-ST segment Elevation myocardial infarction (NSTEMI) is underestimated. Purpose: In this study, we aimed to assess the incidence and impact of totally occluded culprit artery on in-hospital and six months follow up outcomes of NSTEMI acute coronary syndrome (ACS) patients. Results: This observational retrospective study was conducted on consecutive NSTEMI patients who presented to the Alexandria Main University hospital, Egypt between 1st June 2016 and 31st May 2017. All patients were managed with PCI within 72 hours of presentation. We excluded patients with cardiogenic shock, prior CABG, STEMI. Patients were divided into two groups according to pre-procedural culprit vessel Thrombolysis in Myocardial Infarction (TIMI) flow. Group 1: TIMI flow 0 total coronary occlusion included 112 patients (22.4%).Group 2: TIMI flow 1 –3 non-total occlusion included 388 patients (77.6%).Group 1 patients had significantly higher incidence of smoking (P=0.01),significantly higher level of cardiac enzymes (P<0.001), significantly more collaterals (P<0.001) and significantly more LCX and RCA as the culprit vessel (P<0.01), while group 2 patients had significantly higher incidence of diabetes(P=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between two groups regarding to major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% vs. 1%, P=0.07) but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% vs. 1%, P=0.007). There were no significant differences regarding MACCE between two groups after 6 months follow-up (5.4% vs. 4.6%, P=0.24). Conclusion: Approximately 25% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after six months follow up but was associated with significantly higher incidence of in-hospital arrhythmia.