Abstract

Research Article

Assessment of risk factors and MACE rate among occluded and non-occluded NSTEMI patients undergoing coronary artery angiography: A retrospective cross-sectional study in Multan, Pakistan

Ibtasam Ahmad, Muhammad Haris, Amnah Javed and Muhammad Azhar*

Published: 30 May, 2018 | Volume 3 - Issue 2 | Pages: 023-030

Objectives: The prime focus of the present study was to evaluate the most occluded coronary artery (OCA) among non-ST elevated myocardial infarction (NSTEMI) patients, and risk factors associated with occluded and non-occluded NSTEMI. Also, major adverse cardiovascular event (MACE) were evaluated among patients during index hospitalization.

Methods: A retrospective, cross-sectional study was conducted in Multan Institute of Cardiology, Pakistan between 1st February, 2017, and 31st September, 2017. The data were collected from medical records of the outpatients and inpatients who were index hospitalized. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) And Microsoft Excel (MS Office 2010).

Results: Among 624 patients, angiographic findings revealed that 63.9% were suffering from non-occlusive NSTEMI while 36.1% of the patients had occluded NSTEMI. In occluded NSTEMI patients, 30.3% were having single vessel occlusion while 5.8% were having multi-vessel occlusion. Also, 49.8% were having occlusion of right coronary artery (CA) while 44% were having occluded left anterior descending (LAD) artery. Multivariate analysis revealed that age (p=0.001) and left ventricular ejection fraction (LVEF) (p=0.001) had a statistically significant association. The incidence of MACE was high among non-OCA patients as compared to OCA patients but no statistically significant association was found (p=0.44).

Conclusions: Angiography confirmed that most of the NSTEMI patients had OCA. But the MACE rate was not significantly differ among OCA and non-OCA patients. The risk factors associated with OCA were low LVEF and age.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001023 Cite this Article Read Full Article PDF

Keywords:

Occluded coronary artery; Risk factors; Angiography; Non-ST elevation myocardial infarction; Major adverse cardiovascular event

References

  1. Ruff, CT and Braunwald E, The evolving epidemiology of acute coronary syndromes. Nat Rev Cardiol. 2011; 8: 140-147. Ref.: https://goo.gl/9y6krt
  2. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010; 362: 2155-2165. Ref.: https://goo.gl/hFmFjo
  3. Roe MT, White JA, Kaul P, Tricoci P, Lokhnygina Y, et al., Regional patterns of use of a medical management strategy for patients with non–ST-segment elevation acute coronary syndromes: insights from the EARLY ACS Trial. Circ Cardiovasc Qual Outcomes. 2012; 5: 205-213. Ref.: https://goo.gl/6A1VD1
  4. Katritsis DG, Siontis GC, Kastrati A, van't Hof AW, Neumann FJ, et al. Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes. Eur Heart J. 2011; 32: 32-40. Ref.: https://goo.gl/ZJu6zk
  5. Warnica JW, Acute Myocardial Infarction (MI). MSD Mannual. 2016. Ref.: https://goo.gl/MfiqST
  6. Bonow O, Mann D, Zipes D, Libby P. Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine. 2011. Ref.: https://goo.gl/t4saoZ
  7. Francone M, Bucciarelli-Ducci C, Carbone I, Canali E, Scardala R, et al. Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size and Microvascular Damage in Patients with ST-Elevation Myocardial Infarction: Insight from Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2009; 54: 2145-2153. Ref.: https://goo.gl/rN4jaH
  8. Brodie BR, Stone GW, Cox DA, Stuckey TD, Turco M, et al. Impact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction: analysis from the CADILLAC trial. Am Heart J. 2006; 151: 1231-1238. Ref.: https://goo.gl/EUKi3f
  9. Navarese SEP, Servi De C, Gibson AM, Buffon F, Castriota J, et al. Early vs. delayed invasive strategy in patients with acute coronary syndromes without ST-segment elevation: a meta-analysis of randomized studies. QJM: An Int J Med. 2011; 104: 193-200. Ref.: https://goo.gl/Lg4ASj
  10. Riezebos RK. Percutaneous coronary intervention for non ST-elevation acute coronary syndromes: which, when and how? American Journal of Cardiology. 2011; 107: 509-515.
  11. Casey DE, Jneid H, Anderson JL, Wright RS, Adams CD, et al. 2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update). J Am Coll Cardiol. 2012; 60: 645-681. Ref.: https://goo.gl/pwtCpZ
  12. McClelland AJ, Owens CG, Menown IB, Lown M, Adgey AA. Comparison of value of leads from body surface maps to 12-lead electrocardiogram for diagnosis of acute myocardial infarction. Am J Cardiol. 2003; 92: 252-257. Ref.: https://goo.gl/YgpJF5
  13. Wang TY, Zhang M, Fu Y, Armstrong PW, Newby LK, 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: 716-723. Ref.: https://goo.gl/hJAp95
  14. Grenne B, Eek C, Sjøli B, Skulstad H, Aakhus S, et al. Changes of myocardial function in patients with non-ST-elevation acute coronary syndrome awaiting coronary angiography. American Journal of Cardiology. 2010; 105: 1212-1218. Ref.: https://goo.gl/Rqe2tA
  15. Dixon WC, Wang TY, Dai D, Shunk KA, Peterson ED, et al. 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: 1347-1348. Ref.: https://goo.gl/p9p9sZ
  16. 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. Clinical Research in Cardiology, 2011; 100: 457-467. Ref.: https://goo.gl/GuKJYG
  17. Koyama, Y., et al., Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. American Journal of Cardiology. 2002; 90: 579-584.
  18. Abbas AE , Boura JA , Brewington SD , Dixon SR , O'Neill WW, et al. Acute angiographic analysis of non–ST-segment elevation acute myocardial infarction. American Journal of Cardiology. 2004; 94: 907-909. Ref.: https://goo.gl/wWNoMn
  19. Rasoul S, de Boer MJ, Suryapranata H, Hoorntje JCA, Gosselink ATM, et al. Circumflex artery-related acute myocardial infarction: limited ECG abnormalities but poor outcome. Neth Heart J. 2007; 15: 286-290. Ref.: https://goo.gl/Tu8Jb7
  20. Kim MC, Ahn Y, Rhew SH, Jeong HM, Kim JH, 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. International heart journal. 2012; 53: 160-164. Ref.: https://goo.gl/JWBYsK
  21. Song YB , Hahn JY , Kim JH , Lee SY , Choi SH , et al., Comparison of angiographic and other findings and mortality in non–ST-segment elevation versus ST-segment elevation myocardial infarction in patients undergoing early invasive intervention. American Journal of Cardiology. 2010; 106: 1397-1403. Ref.: https://goo.gl/UU9s8S
  22. Daly MJ, Finlay DD, Guldenring D, Nugent CD, Tomlin A, et al., Detection of acute coronary occlusion in patients with acute coronary syndromes presenting with isolated ST-segment depression. Eur Heart J Acute Cardiovasc Care. 2012; 1:128-135. Ref.: https://goo.gl/vpUooY
  23. Grenne B, Eek C, Sjøli B, Dahlslett T, Uchto M, et al. Acute coronary occlusion in non-ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography. Heart. 2010; 96: 1550-1556. Ref.: https://goo.gl/LxWosQ

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?