Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded “culprit” artery – a systemic review and meta-analysis

Authors: Chi-Sheng Hung, Ying-Hsien Chen, Ching-Chang Huang, Mao-Shin Lin, Chih-Fan Yeh, Hung-Yuan Li, Hsien-Li Kao

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

The aim was to determine the prevalence and impact of an occluded “culprit” artery (OCA) in patients with non-ST segment elevation myocardial infarction (NSTEMI).

Methods

We searched PubMed, EMBASE, and Web of Science, with no language restrictions, up to 1 Jul. 2016. Observational cohorts or clinical trials of adult NSTEMI were eligible for inclusion to determine the prevalence if the proportion of OCA on coronary angiography was reported. Studies were further eligible for inclusion to determine the outcome if the association between OCA and clinical endpoints was reported.

Results

Among the 60,898 patients with NSTEMI enrolled in 25 studies, 17,212 were found to have OCA. The average proportion of OCA in NSTEMI was 34% (95% CI 30–37%). Patients with OCA were more likely to have left circumflex artery as their culprit artery (odds ratio (OR) 1.65, 95% CI 1.15–2.37, p = 0.007), and this was associated with lower left ventricular ejection fraction (standard mean difference -0.29, 95% CI -0.34 to -0.34, p < 0.001), higher peak enzyme level (standard mean difference 0.43, 95% CI 0.27–0.58, p < 0.001), and higher risk for cardiogenic shock (OR 1.66, 95% CI 1.35–2.04, p < 0.001), compared with patients with a non-occlusive culprit artery. Death rate (OR 1.72, 95% CI 1.49–1.98, p < 0.001) and recurrent myocardial infarction (OR 1.7, 95% CI 1.06–2.75, p = 0.029) were also higher in patients with OCA, compared with patients with a non-occlusive culprit artery.

Conclusions

Patients with OCA comprised a substantial portion of the NSTEMI population. These patients present with more severe symptoms and worse clinical outcome. Whether these patients should be treated with more aggressive strategy warrants further study.
Appendix
Available only for authorised users
Literature
1.
O’Gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):529–55.CrossRefPubMed
2.
Amsterdam EA, Wenger NK, Brindis RG, Casey Jr DE, Ganiats TG, Holmes Jr DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, et al. 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–228.CrossRefPubMed
3.
O’Donoghue M, Boden WE, Braunwald E, Cannon CP, Clayton TC, de Winter RJ, Fox KA, Lagerqvist B, McCullough PA, Murphy SA, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2008;300(1):71–80.CrossRefPubMed
4.
DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303(16):897–902.CrossRefPubMed
5.
Dixon WC, Wang TY, Dai D, Shunk KA, Peterson ED, Roe MT, National Cardiovascular Data R. Anatomic distribution of the culprit lesion in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: findings from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2008;52(16):1347–8.CrossRefPubMed
6.
Wang TY, Zhang M, Fu Y, Armstrong PW, Newby LK, Gibson CM, Moliterno DJ, Van de Werf F, White HD, Harrington RA, et al. Incidence, distribution, and prognostic impact of occluded culprit arteries among patients with non-ST-elevation acute coronary syndromes undergoing diagnostic angiography. Am Heart J. 2009;157(4):716–23.CrossRefPubMed
7.
Kim MC, Ahn Y, Rhew SH, Jeong MH, Kim JH, Hong YJ, Chae SC, Kim YJ, Hur SH, Seong IW, et al. Impact of total occlusion of an infarct-related artery on long-term mortality in acute non-ST-elevation myocardial infarction patients who underwent early percutaneous coronary intervention. Int Heart J. 2012;53(3):160–4.CrossRefPubMed
8.
Shin DI, Chang K, Ahn Y, Hwang BH, Park HJ, Seo SM, Koh YS, Kim PJ, Seung KB, Jeong MH. Impact of occluded culprit arteries on long-term clinical outcome in patients with non-ST-elevation myocardial infarction: 48-month follow-up results in the COREA-AMI Registry. J Interv Cardiol. 2014;27(1):12–20.CrossRefPubMed
9.
Pride YB, Tung P, Mohanavelu S, Zorkun C, Wiviott SD, Antman EM, Giugliano R, Braunwald E, Gibson CM, Group TS. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression: a TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38) substudy. J Am Coll Cardiol Intv. 2010;3(8):806–11.CrossRef
10.
Jung DH, Jeong MH, Kim KH, Lee WS, Lee KH, Yoon HJ, Yoon NS, Moon JY, Hong YJ, Park HW, Kim JH, Ahn YK, et al. Predictors of total occlusion of the infarct-related artery in patients with acute Non-ST elevation myocardial infarction. Korean J Med. 2008;74:271–80.
11.
Bahrmann P, Rach J, Desch S, Schuler GC, Thiele H. Incidence and distribution of occluded culprit arteries and impact of coronary collaterals on outcome in patients with non-ST-segment elevation myocardial infarction and early invasive treatment strategy. Clin Res Cardiol. 2011;100(5):457–67.CrossRefPubMed
12.
Warren J, Mehran R, Yu J, Xu K, Bertrand ME, Cox DA, Lincoff AM, Manoukian SV, Ohman EM, Pocock SJ, et al. Incidence and impact of totally occluded culprit coronary arteries in patients presenting with non-ST-segment elevation myocardial infarction. Am J Cardiol. 2015;115(4):428–33.CrossRefPubMed
13.
14.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7), e1000097.CrossRefPubMedPubMedCentral
15.
16.
17.
18.
Yazici M, Demircan S, Durna K. Association between nitric oxide levels on myocardial injury in non-ST elevation acute coronary syndromes. J Thromb Thrombolysis. 2007;24(2):145–51.CrossRefPubMed
19.
Abbott JD, Ahmed HN, Vlachos HA, Selzer F, Williams DO. Comparison of outcome in patients with ST-elevation versus non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry). Am J Cardiol. 2007;100(2):190–5.CrossRefPubMed
20.
Karwowski J, Polonski L, Gierlotka M, Gasior M, Beckowski M, Kowalik I, Szwed H. Post-procedural TIMI flow grade 2 is not associated with improved prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization (PL-ACS registry). Cardiol J. 2016;23(4):402–10.CrossRefPubMed
21.
Soon K, Du HN, Klim S, Zakariyya A, Kelly AM. Non-ST elevation myocardial infarction with occluded artery and its clinical implications. Heart Lung Circ. 2014;23(12):1132–40.CrossRefPubMed
22.
Aijaz S, Hanif B. Frequency and distribution of angiographically occluded coronary artery and in-hospital outcome of patients with non ST elevation myocardial infarction. J Pak Med Assoc. 2016;66(5):504–8.PubMed
23.
Daly M, Finlay D, Guldenring D, Nugent C, Tomlin A, Smith B, Adgey A, Harbinson M. Detection of acute coronary occlusion in patients with acute coronary syndromes presenting with isolated ST-segment depression. Eur Heart J Acute Cardiovasc Care. 2012;1(2):128–35.CrossRefPubMedPubMedCentral
24.
Ojio S, Takatsu H, Tanaka T, Ueno K, Yokoya K, Matsubara T, Suzuki T, Watanabe S, Morita N, Kawasaki M, et al. Considerable time from the onset of plaque rupture and/or thrombi until the onset of acute myocardial infarction in humans: coronary angiographic findings within 1 week before the onset of infarction. Circulation. 2000;102(17):2063–9.CrossRefPubMed
25.
Budoff MJ, Yang TP, Shavelle RM, Lamont DH, Brundage BH. Ethnic differences in coronary atherosclerosis. J Am Coll Cardiol. 2002;39(3):408–12.CrossRefPubMed
26.
Shaw LJ, Shaw RE, Merz CN, Brindis RG, Klein LW, Nallamothu B, Douglas PS, Krone RJ, McKay CR, Block PC, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation. 2008;117(14):1787–801.CrossRefPubMed
27.
Tillin T, Dhutia H, Chambers J, Malik I, Coady E, Mayet J, Wright AR, Kooner J, Shore A, Thom S, et al. South Asian men have different patterns of coronary artery disease when compared with European men. Int J Cardiol. 2008;129(3):406–13.CrossRefPubMed
28.
Kalaycı B, Sayin MR. A rare cause of non-ST elevation myocardial infarction related to total coronary artery occlusion: dual RCA. Int J Cardiovasc Acad. 2016;2(3):134–6.CrossRef
29.
Matetzky S, Freimark D, Feinberg MS, Novikov I, Rath S, Rabinowitz B, Kaplinsky E, Hod H. Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9: “hidden” ST-segment elevations revealing acute posterior infarction. J Am Coll Cardiol. 1999;34(3):748–53.CrossRefPubMed
30.
Khan JN, Chauhan A, Mozdiak E, Khan JM, Varma C. Posterior myocardial infarction: are we failing to diagnose this? Emerg Med J. 2012;29(1):15–8.CrossRefPubMed
31.
Waldo SW, Brenner DA, Li S, Alexander K, Ganz P. Reperfusion times and in-hospital outcomes among patients with an isolated posterior myocardial infarction: insights from the National Cardiovascular Data Registry (NCDR). Am Heart J. 2014;167(3):350–4.CrossRefPubMed
32.
Kim SS, Choi HS, Jeong MH, Cho JG, Ahn YK, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, et al. Clinical outcomes of acute myocardial infarction with occluded left circumflex artery. J Cardiol. 2011;57(3):290–6.CrossRefPubMed
33.
Wong GC, Morrow DA, Murphy S, Kraimer N, Pai R, James D, Robertson DH, Demopoulos LA, DiBattiste P, Cannon CP, et al. Elevations in troponin T and I are associated with abnormal tissue level perfusion: a TACTICS-TIMI 18 substudy. Circulation. 2002;106(2):202–7.CrossRefPubMed
34.
Koyama Y, Hansen PS, Hanratty CG, Nelson GI, Rasmussen HH. Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. Am J Cardiol. 2002;90(6):579–84.CrossRefPubMed
35.
Bolognese L, Ducci K, Angioli P, Falsini G, Liistro F, Baldassarre S, Burali A. Elevations in troponin I after percutaneous coronary interventions are associated with abnormal tissue-level perfusion in high-risk patients with non-ST-segment-elevation acute coronary syndromes. Circulation. 2004;110(12):1592–7.CrossRefPubMed
36.
Abbas AE, Boura JA, Brewington SD, Dixon SR, O’Neill WW, Grines CL. Acute angiographic analysis of non-ST-segment elevation acute myocardial infarction. Am J Cardiol. 2004;94(7):907–9.CrossRefPubMed
37.
Mazurek M, Kowalczyk J, Lenarczyk R, Swiatkowski A, Kowalski O, Sedkowska A, Was T, Swierad M, Pruszkowska-Skrzep P, Kurek T, et al. The impact of unsuccessful percutaneous coronary intervention on short- and long-term prognosis in STEMI and NSTEMI. Catheter Cardiovasc Interv. 2011;78(4):514–22.CrossRefPubMed
38.
Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M, Laugwitz KL, Pache J, Ott I, Hausleiter J, et al. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N Engl J Med. 2011;365(21):1980–9.CrossRefPubMed
39.
Widimsky P, Rohac F, Stasek J, Kala P, Rokyta R, Kuzmanov B, Jakl M, Poloczek M, Kanovsky J, Bernat I, et al. Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy? Eur Heart J. 2012;33(1):86–95.CrossRefPubMed
40.
Park HW, Yoon CH, Kang SH, Choi DJ, Kim HS, Cho MC, Kim YJ, Chae SC, Yoon JH, Gwon HC, et al. Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Int J Cardiol. 2013;169(4):254–61.CrossRefPubMed
41.
Zhang D, Wang L, Wang H, Xu L, Li W, Ni Z, Xia K, Liu X. The effects of tirofiban on acute non-ST segment elevation myocardial infarction patients not receiving early reperfusion intervention. Chin J Intern Med. 2014;33(3):193–7.
42.
Guerra E, Hadamitzky M, Ndrepepa G, Bauer C, Ibrahim T, Ott I, Laugwitz KL, Schunkert H, Kastrati A. Microvascular obstruction in patients with non-ST-elevation myocardial infarction: a contrast-enhanced cardiac magnetic resonance study. Int J Card Imaging. 2014;30(6):1087–95.CrossRef
43.
Liu N, Hou M, Ren W, Cao J, Wu H, Zhou W. Clinical research of treatment with tirofiban for high-risk non-ST-segment elevation acute coronary syndrome during peri-operative intervention operation period. Cell Biochem Biophys. 2015;71(1):43–7.CrossRefPubMed
44.
Misumida N, Kobayashi A, Saeed M, Fox JT, Kanei Y. Association between preinfarction angina and angiographic findings in non-ST-segment elevation myocardial infarction. Clin Cardiol. 2015;38(9):535–41.CrossRefPubMed
Metadata
Title
Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded “culprit” artery – a systemic review and meta-analysis
Authors
Chi-Sheng Hung
Ying-Hsien Chen
Ching-Chang Huang
Mao-Shin Lin
Chih-Fan Yeh
Hung-Yuan Li
Hsien-Li Kao
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-1944-x

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Research

Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy

Research

Performance comparison of ventricular and arterial dP/dtmax for assessing left ventricular systolic function during different experimental loading and contractile conditions

Research

Intrapulmonary autologous transplant of bone marrow-derived mesenchymal stromal cells improves lipopolysaccharide-induced acute respiratory distress syndrome in rabbit

Viewpoint

Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions

Research

Exosomes from patients with septic shock convey miRNAs related to inflammation and cell cycle regulation: new signaling pathways in sepsis?

Research

Driving-pressure-independent protective effects of open lung approach against experimental acute respiratory distress syndrome