Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort
Main finding · MACE in NSTE-ACS, LCx occlusionResult — go to the resultHazard ratio 1.68 95% CI 1.10–2.59Authors' conclusion
In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.
Study context
- Population
- ACS patients (ST-elevation myocardial infarction (STEMI) n = 2469; NSTE-ACS n = 1943) recruited 2009–2017 in SPUM-ACS4,787 recruited
- Participants
- 4,412 patients
- Exposure
- Infarct-related artery (IRA) location in ACS with and without ST-elevation
- Right coronary artery (RCA)n = 1,494reference
- LADn = 2,013reference
- Left circumflex (LCx)n = 905
- Outcome
- MACE:
- All-cause death
- Non-fatal MI
- Non-fatal stroke
- Follow-up
- 1 year
Methodological detailsmultivariable-adjusted
- Multivariable-adjusted
Main finding
MACE in NSTE-ACS, LCx occlusion
Hazard ratio
1.68
95% CI 1.10–2.59
P = 0.02
As reported in the abstract
Observational data: associations, not effects.
Further findings
TCO (TIMI 0 flow) in STEMI
TCO in NSTE-ACS
- Total coronary occlusion (TCO) in NSTE-ACS: LCx and RCA vs LAD P < 0.001
Features associated with TCO in NSTE-ACS
- Elevated lymphocyte and neutrophil counts, higher high-sensitivity C reactive protein (hs-CRP) and hs-cTnT, lower eGFR, negative history of MI
Original publication
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