Article ; Online: Prevalence and clinical significance of totally occluded infarct-related arteries in patients with non-ST-segment elevation acute coronary syndromes.
International journal of cardiology
2020 Volume 324, Page(s) 1–7
Abstract: Background Seemingly conflicting findings exist regarding the prognostic impact of totally occluded infarct-related arteries (oIRA) in non-ST elevation acute coronary syndromes (NSTE-ACS). Methods Retrospective analysis of prospective multicenter ... ...
Abstract | Background Seemingly conflicting findings exist regarding the prognostic impact of totally occluded infarct-related arteries (oIRA) in non-ST elevation acute coronary syndromes (NSTE-ACS). Methods Retrospective analysis of prospective multicenter registry data comprising a single-center NSTE-ACS cohort, aimed at assessing the impact of occluded (TIMI flow 0/1) versus patent culprit vessels (pIRA, TIMI flow 2/3) on the composite endpoint of all-cause death and cardiogenic shock events at 30 days. Results Of 568 patients, 183 (32.5%) had oIRA. Male sex, refractory angina, ECG suggestive of multivessel or left main disease, and larger infarct sizes with inferior/posterolateral wall involvement, were identified as highly specific markers of oIRA. Successful culprit-lesion revascularization occurred more frequently in patent than in oIRA (90% vs. 96%; P = 0.013). Conversely, patients with oIRA more frequently achieved successful revascularization of concurrent non-IRAs including chronic total occlusions than did those with pIRA (28% vs. 3%; P = 0.0005). Multivariate analysis revealed neutral effects of oIRA on outcomes and identified incomplete revascularization as a powerful predictor of mortality. Moderation analysis revealed a significant interaction between completeness of revascularization and IRA patency, whereby among the incompletely revascularized patients, those with oIRA enjoyed a significant survival advantage over their counterparts with pIRA (11.8% vs. 28%, adjusted OR 0.34; 95% CI 0.10-0.73; P |
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MeSH term(s) | Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/epidemiology ; Arteries ; Coronary Angiography ; Humans ; Male ; Percutaneous Coronary Intervention ; Prevalence ; Prospective Studies ; Retrospective Studies ; Treatment Outcome |
Language | English |
Publishing date | 2020-09-13 |
Publishing country | Netherlands |
Document type | Journal Article ; Multicenter Study |
ZDB-ID | 779519-1 |
ISSN | 1874-1754 ; 0167-5273 |
ISSN (online) | 1874-1754 |
ISSN | 0167-5273 |
DOI | 10.1016/j.ijcard.2020.09.040 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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