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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

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Abstract

Background

It is assumed that patients with non-ST-elevation myocardial infarctions (NSTEMI) showing an infero- or posterolateral occluded culprit artery (OCA) during diagnostic angiography frequently elude standard 12-lead electrocardiogram diagnosis. In addition, coronary collaterals may have beneficial effects in patients with OCA.

Methods

We examined 448 consecutive NSTEMI patients within 72 h of symptom onset. All patients underwent early invasive angiography plus optimal medical therapy. We compared clinical characteristics and 30-days/6-month major adverse cardiovascular events (MACE) between patients with OCA and non-OCA. The secondary objective was to investigate the effect of angiographically visible coronary collaterals on 6-month MACE in patients with OCA.

Results

The angiograms revealed OCA in 130 (29%) of 448 patients. Patients with OCA showed more often infero- or posterolateral lesions (75 vs. 53%, p < 0.001) and more collaterals (57 vs. 8%, p < 0.001) compared with those with non-OCA. Patients with OCA had larger infarcts (peak CK-MB 2.1 ± 2.3 vs. 1.2 ± 1.1 μmol/L/s, p < 0.001), lower left ventricular ejection fraction (42 ± 21 vs. 48 ± 20%, p = 0.01), were more often revascularized (89 vs. 78%, p = 0.005), and had higher risk-adjusted 6-month MACE largely driven by its association with non-fatal reinfarctions (HR 2.16, 95% CI 1.04–4.50, p = 0.04). Patients with OCA and angiographically absent collaterals had significantly higher risk-adjusted 6-month MACE than those with OCA and angiographically visible collaterals (HR 1.96, 95% CI 1.02–3.76, p = 0.04).

Conclusions

Approximately one-fourth of patients with NSTEMI revealed OCA that was more frequently found in coronary arteries supplying the infero- or posterolateral myocardium. Patients with OCA had larger infarcts and more non-fatal reinfarctions than patients with non-OCA. Well-developed collaterals may limit the myocardial damage in these patients.

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Abbreviations

ACE:

Angiotensin-converting enzyme

ACS:

Acute coronary syndrome

CABG:

Coronary arteries bypass graft

CI:

Confidence interval

CK:

Creatine kinase

CK-MB:

Creatine kinase-myocardial band fraction

cTNT:

Troponin T

ECG:

Electrocardiogram

HR:

Hazard ratio

MACE:

Major adverse cardiovascular events

MI:

Myocardial infarction

NSTEMI:

Non-ST-segment elevation myocardial infarction

OCA:

Occluded culprit artery

PCI:

Percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

TIMI:

Thrombolysis in myocardial infarction

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, 04289, Leipzig, Germany

    Philipp Bahrmann, Justus Rach, Steffen Desch, Gerhard C. Schuler & Holger Thiele

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  1. Philipp Bahrmann
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Correspondence to Philipp Bahrmann.

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Bahrmann, P., Rach, J., Desch, S. et al. 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 100, 457–467 (2011). https://doi.org/10.1007/s00392-010-0269-9

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