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Coronary disease & ACS

Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention

JACC Cardiovasc IntervPublished

  • Registry study (CathPCI Registry)
  • sensitivity analysis with ACO defined as 100% acute occlusion or TIMI flow grade 0 or 1 in the culprit artery
+1 more
  • sensitivity analysis with ACO defined as 100% acute occlusion or TIMI flow grade 0 or 1 in the culprit artery
Read the original article ↗

Authors' conclusion

ACO occurs in a substantial proportion of patients with NSTEMI and is associated with worse in-hospital outcomes relative to those with NSTEMI-no-ACO. Further studies of early identification and reperfusion practices for NSTEMI-ACO are warranted.

Study context

Population
Patients with STEMI and NSTEMI in the CathPCI Registry who underwent percutaneous coronary intervention between April 1, 2018, and June 30, 2023
Participants
1,198,544 patients
Exposure
NSTEMI-ACO compared with NSTEMI-no-ACO and with STEMI
Outcome
Composite of:
  • In-hospital stroke
  • Myocardial infarction
  • Cardiovascular mortality
Follow-up
In-hospital

Main finding

As reported in the abstract

Composite of:
  • In-hospital stroke
  • Myocardial infarction
  • Cardiovascular mortality
Adjusted odds ratio (95% CI)P value
NSTEMI-ACO vs NSTEMI-no-ACOhigher risk with NSTEMI-ACO
2.26(2.18–2.34)
P < 0.001
NSTEMI-ACO vs STEMIlower risk with NSTEMI-ACO
0.54(0.52–0.56)
P < 0.001

Observational data: associations, not effects.

Further findings

Cardiogenic shock

Ventricular arrhythmias

In-hospital cardiac arrest

Distribution of presentations

share of patients with NSTEMI NSTEMI-ACO 15%

OutcomeSTEMINSTEMI-ACONSTEMI-no-ACO
Sensitivity analysis: ACO including TIMI flow grade 0 or 1Not reported in the abstract24.4% of NSTEMINot reported in the abstractSTEMI, NSTEMI-no-ACO: not reported in the abstract
  • Cardiogenic shock: P < 0.001
  • Ventricular arrhythmias: P < 0.001
  • In-hospital cardiac arrest: P < 0.001
  • Distribution of presentations: NSTEMI-ACO was 15% of those with NSTEMI

Sensitivity analysis: ACO including TIMI flow grade 0 or 1

In-hospital outcomes similarly worse compared with NSTEMI-no-ACO and better compared with STEMI

Original publication

Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv. Published 12 October 2026. doi:10.1016/j.jcin.2026.07.032
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Summarised from the published abstract; every number is checked against it