Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality
Authors' conclusion
Non-ST-elevation myocardial infarction patients with ATO have unfavourable procedural outcomes, resulting in increased long-term mortality, resembling STEMI.
Study context
- Population
- Patients with acute MI undergoing invasive coronary angiography at a single centre, 2004–20191,605 non-ST-elevation myocardial infarction (NSTEMI)
- Participants
- 2,269 patients
- Exposure
- NSTEMI with acute total occlusion (ATO) vs NSTEMI without ATO vs STEMI
- ATO(+)NSTEMIn = 471
- STEMIn = 664
- Outcome
- Long-term all-cause mortality
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
ATO(+)NSTEMI · 60% increased incident mortality
1.60
CI 1.27–2.02P < 0.0001
STEMI · 55% increased incident mortality
1.55
CI 1.24–1.94P < 0.0001
Observational data: associations, not effects.
Further findings
- LVEF — STEMI
- 49.1 ± 11 %
- Global longitudinal strain — STEMI
- −15.5 ± −4.84 %
- LVEF: ATO(+)NSTEMI 48.5 ± 12.7 %
- LVEF: ATO(-)NSTEMI 50.6 ± 11.8 %
- LVEF: ATO(+)NSTEMI vs STEMI P = 0.5
- LVEF: ATO(+)NSTEMI vs ATO(-)NSTEMI P = 0.018
- Global longitudinal strain: ATO(+)NSTEMI −15.2 ± −5.74 %
- Global longitudinal strain: ATO(-)NSTEMI −16.3 ± −5.30 %
- Global longitudinal strain: ATO(+)NSTEMI vs STEMI P = 0.48
- Global longitudinal strain: ATO(+)NSTEMI vs ATO(-)NSTEMI P = 0.016
Safety
%
- Cardiogenic shock — STEMI
- 2.86
- No reflow — STEMI
- 3.17
- Cardiogenic shock: ATO(+)NSTEMI 2.76 %
- Cardiogenic shock: ATO(-)NSTEMI 0.27 %
- Cardiogenic shock: ATO(+)NSTEMI vs ATO(-)NSTEMI P < 0.0001
- Cardiogenic shock: ATO(+)NSTEMI vs STEMI P = 1
- No reflow: ATO(+)NSTEMI 4.03 %
- No reflow: ATO(-)NSTEMI 0.18 %
- No reflow: ATO(+)NSTEMI vs ATO(-)NSTEMI P < 0.0001
- No reflow: ATO(+)NSTEMI vs STEMI P = 0.54
Original publication
Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality. Eur Heart J Qual Care Clin Outcomes. Published 8 January 2024. doi:10.
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