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
Article Sidebar
Main Article Content
Abstract
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.
Article Details
Copyright (c) 2018 Ahmad I, et al.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Journal of Cardiology and Cardiovascular Medicine is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.
License: Copyright © 2017 - 2025 | 
Open Access by Journal of Cardiology and Cardiovascular Medicine is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.
With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.
Compliance 'CC BY' license helps in:
| Permission to read and download | ✓ |
| Permission to display in a repository | ✓ |
| Permission to translate | ✓ |
| Commercial uses of manuscript | ✓ |
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
Ruff, CT and Braunwald E, The evolving epidemiology of acute coronary syndromes. Nat Rev Cardiol. 2011; 8: 140-147. Ref.: https://goo.gl/9y6krt
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
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
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
Warnica JW, Acute Myocardial Infarction (MI). MSD Mannual. 2016. Ref.: https://goo.gl/MfiqST
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
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
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
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
Riezebos RK. Percutaneous coronary intervention for non ST-elevation acute coronary syndromes: which, when and how? American Journal of Cardiology. 2011; 107: 509-515.
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
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
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
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
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
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
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.
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
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
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
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
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
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