Incidence, distribution, and prognostic impact of occluded culprit arteries among patients with non–ST-elevation acute coronary syndromes undergoing diagnostic angiography

• Published in: The American heart journal Vol. 157; no. 4; pp. 716 - 723
• Main Authors: Wang, Tracy Y., MD, MHS, Zhang, Min, PhD, Fu, Yuling, MD, Armstrong, Paul W., MD, Newby, L. Kristin, MD, MHS, Gibson, C. Michael, MD, MS, Moliterno, David J., MD, Van de Werf, Frans, MD, PhD, White, Harvey D., DSc, Harrington, Robert A., MD, Roe, Matthew T., MD, MHS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2009; Mosby; Elsevier Limited
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Coronary Angiography - methods; Coronary heart disease; Coronary Stenosis - diagnosis; Coronary Stenosis - epidemiology; Coronary Stenosis - etiology; Coronary vessels; Double-Blind Method; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Hospitalization; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Time Factors; Veins & arteries; Human; Prognosis; Radiodiagnosis; Angiography; Cardiovascular disease; Coronary heart disease; Epidemiology; Myocardial disease; Artery; Incidence; ST elevation; Distribution; Circulatory system; Diagnosis; Cardiology; Acute coronary syndrome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2009.01.004

Background Because acute occlusion of coronary arteries supplying the inferolateral myocardium frequently eludes standard 12-lead electrocardiogram (ECG) diagnosis, these patients may present as non–ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods We examined culprit artery occlusion among 1,957 NSTE-ACS patients in the Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network trial who underwent diagnostic coronary angiography. We compared baseline characteristics, electrocardiographic findings, in-hospital treatment, and long-term outcomes between patients with and without occluded culprit arteries. Results The culprit artery was occluded in 528 (27%) patients. Culprit lesions were more frequently identified in the inferolateral territory among patients with an occluded culprit artery (63%) compared with those with a nonoccluded artery (45%, P < .0001). Patients with an occluded culprit artery were younger, more often male, and more likely to have had a prior myocardial infarction. Despite similar in-hospital treatment, patients with an occluded culprit artery had larger infarcts (median peak creatine kinase–MB 4.3 vs 2.1 × upper limit of normal, P < .0001) and higher risk-adjusted 6-month mortality (hazard ratio 1.72, 95% CI 1.07-2.79). Conclusions More than 25% of NSTE-ACS patients had an occluded culprit artery on angiography. These patients may represent ST-segment elevation myocardial infarction equivalents; thus, improved early risk stratification techniques would help more rapidly triage these high-risk patients to an early invasive management strategy.