Frequency and Prognosis of Alternative Definitions of Occlusion Myocardial Infarction Across the Whole Spectrum of Acute Coronary Syndromes

IF 12.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2026-10-12 DOI:10.1016/j.jcin.2026.08.007

Andrea Milzi MD, Andrea Zito MD, Antonio Landi MD PhD, Enrico Frigoli MD, Giuseppe Andò MD, Giacomo Boccuzzi MD, Paolo Calabrò MD, Gianluca Campo MD, Marco Frazzetto MD, Marco Covani MD, Jose Maria De La Torre Hernandez MD, Dik Heg PhD, Sergio Leonardi MD, Filippo Russo MD, Gennaro Sardella MD, Arnoud WJ. Vant’Hof MD, Ferdinando Varbella MD, Pascal Vranckx MD, Marco Valgimigli MD

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引用次数: 0

Abstract

Background

Occlusion myocardial infarction (OMI) refers to a myocardial infarction caused by a persistent or transient, complete or near-complete coronary artery occlusion. Multiple definitions have been proposed, yet their frequency and comparative prognostic relevance remain unclear.

Objectives

This study sought to evaluate the frequency and prognosis of previously proposed OMI definitions across the whole spectrum of acute coronary syndromes (ACS) from the MATRIX trial.

Methods

Five alternative OMI definitions were assessed: 1) culprit artery (CA) TIMI flow grade 0; 2) CA-TIMI flow grade 0-1; 3) CA-TIMI flow grade 0-2; 4) CA-TIMI flow grade 0-2 or TIMI flow grade 3 with cardiac troponin >30× upper reference limit; and 5) CA-TIMI flow grade 0-2 or CA-TIMI flow grade 3 with cardiac troponin >100× upper reference limit. The endpoint of interest was 1-year all-cause mortality.

Results

Among 6,558 patients with ACS, OMI frequency ranged from 37.8% for definition 1 to 76.1% for definition 4. OMI was independently associated with higher 1-year mortality according to definitions 1-4 (adjusted HR: 2.08 [95% CI: 1.56-2.78], 1.97[1.47-2.63], 1.70 [1.25-2.32], 1.47 [1.01-2.12], respectively) but not according to definition 5 (adjusted HR: 1.26 [0.90-1.75]). OMI definitions exclusively based on impaired CA flow (ie, definitions 1-3) improved discrimination, reclassification, and model fit when added to the conventional STE/NSTE-ACS classification. One-year mortality did not differ among patients with NSTE-ACS with OMI definition 1 or 2 compared with ST-segment elevation MI (STEMI) patients.

Conclusions

OMI defined by impaired CA flow confers prognostic implications beyond the presence or absence of ST-segment elevation in a broad ACS population and identifies patients without ST-segment elevation with 1-year mortality similar to that of STEMI.

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急性冠状动脉综合征全谱闭塞性心肌梗死的不同定义的频率和预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.