Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention

IF 12.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2026-10-12 DOI:10.1016/j.jcin.2026.07.032

Riyad Yazan Kherallah MD, Syed Zaid MD, Yazan Assaf MD, Angel Chen Marks MS, Glenn Levine MD, Neal S. Kleiman MD, Mirza Umair Khalid MD, Lorraine Mascarenhas MD, Jing Liu MD, Waleed Kayani MD, Yochai Birnbaum MD, Daniel Wojdyla PhD, Rajesh V. Swaminathan MD, Ali A. Denktas MD

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引用次数: 0

Abstract

Background

Patients may present with acute coronary occlusions (ACOs) without manifesting electrocardiographic criteria for ST-segment elevation myocardial infarction (STEMI).

Objectives

The aim of this study was to examine the incidence, clinical characteristics, and in-hospital outcomes of non–ST-segment elevation myocardial infarction (NSTEMI) with ACO.

Methods

The study included patients with STEMI and NSTEMI in the CathPCI Registry who underwent percutaneous coronary intervention between April 1, 2018, and June 30, 2023. ACO was defined as 100% stenosis deemed acute. The cohort was stratified into STEMI (including STEMI equivalents), NSTEMI-ACO, and NSTEMI-no-ACO. The primary outcome was a composite of in-hospital stroke, myocardial infarction, or cardiovascular mortality. A sensitivity analysis with ACO defined as 100% acute occlusion or TIMI flow grade 0 or 1 in the culprit artery was performed.

Results

Of 1,198,544 patients, 26.1% had STEMI, 11.0% had NSTEMI-ACO (15% of whom had NSTEMI), and 62.9% had NSTEMI-no-ACO. Compared with those with NSTEMI-no-ACO, NSTEMI-ACO patients had more cardiogenic shock (9.0% STEMI vs 3.8% NSTEMI-ACO vs 1.9% NSTEMI-no-ACO; P < 0.001), ventricular arrhythmias (4.9% vs 2.0% vs 1.3%; P < 0.001), and in-hospital cardiac arrest (6.1% vs 2.7% vs 1.6%; P < 0.001). Patients with NSTEMI-ACO had a higher risk for the primary composite compared with those with NSTEMI-no-ACO (adjusted OR: 2.26; 95% CI: 2.18-2.34; P < 0.001) but a lower risk compared with those with STEMI (adjusted OR: 0.54; 95% CI: 0.52-0.56; P < 0.001). Using a definition of ACO including TIMI flow grade 0 or 1, NSTEMI-ACO accounted for 216,054 presentations (24.4% of NSTEMI). In-hospital outcomes were similarly worse compared with NSTEMI-no-ACO and better compared with STEMI.

Conclusions

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.

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经皮冠状动脉介入治疗的急性冠状动脉闭塞：来自CathPCI登记的见解。

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.