Clinical implication of totally occluded infarct-related coronary artery in non-ST-segment elevation myocardial infarction: the TOTAL-NSTEMI study. Issue 2 (23rd March 2023)

• Record Type: Journal Article
• Authors: Güner, Ahmet; Çörekçioğlu, Büşra; Uzun, Fatih; Kalçik, Macit; Ulutaş, Ahmet Emir; Akman, Cemalettin; Can, Cemil; Keten, Mustafa Ferhat; Küp, Ayhan; Gürsoy, Mustafa Ozan; Kalkan, Semih; Çizgici, Ahmet Yaşar; Kahraman, Serkan; Güner, Ezgi Gültekin; Külahçioğlu, Şeyhmus; Yalçin, Ahmet Arif; Ertürk, Mehmet
• Is Part Of: Coronary artery disease. Volume 34:Issue 2(2023)
• Page Start: 127
• Page End: 133
• Publication Date: 2023-03-23
• Subjects: fatal arrhythmias -- major cardiovascular and cerebral events -- mechanical complications -- myocardial infarction -- total occlusion; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000001212
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: A subset ofpatients found to have total occlusion of the culprit artery (TOCA), present with non-ST-segment elevation myocardial infarction (NSTEMI) and elevated biomarkers. The aim of this study is to assess the effect of the TOCA in patients presenting with NSTEMI. Methods: This multicenter observational study was retrospectively conducted between 2015 and 2019. Thrombolysis in myocardial infarction (TIMI) flow grades 0–1 was defined as the TOCA. The primary end point included a combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke. Results: Of 3272 patients, TIMI 0–1 flow in the culprit artery was present in 488 (14.9%) patients. TOCA was more likely to be of thrombotic origin (54.1% vs. 10.3%; P < 0.001) and visible collaterals (22.5% vs. 4.4%; P < 0.001). The rates of 30-day (14.3% vs. 7.2%; P < 0.001) and 2-year (25% vs. 19.1%; P = 0.003) primary end points were significantly higher in TOCA patients. Fatal arrhythmias were remarkably higher at 30-day (8.6% vs. 4%; P < 0.001) and 2-year (9% vs. 5.2%; P = 0.001) follow-ups. Mechanical complications were also higher in patients with TOCA at 30 days (0.8% vs. 0.2%; P = 0.013). Moreover, TOCA (OR, 1.379; P = 0.001) was one of the independent predictors of MACCE in NSTEMI patients. Conclusion: The current data suggest that patients with TOCA in the context of NSTEMI are at higher risk of MACCE, fatal arrhythmias, and mechanical complications.