Total occlusion of coronary artery in non-ST segment elevation acute coronary syndrome – analysis of electrocardiographic and clinical data .
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 8
Abstract
Introduction: In contrast to myocardial infarction with persistent ST-segment elevation (STEMI), which is recommended for emergent coronary reperfusion of the artery responsible for the cardiac incident, the approach to patients with myocardial infarction that runs without ST segment elevation (NSTEMI) is more liberal. The up-to-date recommendations of scientific societies assume that angioplasty should be performed not later than 72 hours since the onset of chest pain depending on the estimated baseline risk.Aim: The assessment and outcome of disease in patients in whom on the basis of the baseline electrocardiogram the ACS without ST-segment elevation was finally diagnosed, whereas the acute coronary occlusion responsible for the current cardiac incident was observed.Methods: The study is retrospective. 206 consecutive patients hospitalized for NSTE ACS in the Cardiac Intensive Care and the Department of Cardiology of the Bielanski Hospital in the period from 01/08/2007 to 30/04/2008 (recruitment period - 9 months) were observed. The only exclusion criterion from the study was the presence of ST-segment elevation in baseline electrocardiogram. Then, in this group 39 patients (19%) were selected in whom coronary angiography revealed the acute coronary artery occlusion (TIMI 0). The mean follow-up after discharge from hospital was 26 months (till 31.12.2009).Results: The level of in-hospital mortality (2.56%) is comparable with the number of early deaths in large cardiac registries, both in patients with NSTEMI and STEMI. However, long-term prognosis in these patients is severe and similar to long-term mortality in patients with STEMI. Almost 18% of patients in the target group, suffered from the recurrent coronary syndrome or required percutaneous coronary intervention due to the exacerbation of ischemic heart disease as a result of in-stent restenosis. In the same proportion of patients within an average 2-year follow-up fatal recurrent myocardial ischemia occurred.Conclusions: The characteristics of this group resembles rather the group of patients with STE-ACS. A surprisingly large percentage of patients with NSTE-ACS has LAD or diagonal branch occluded. Electrocardiogram did not indicate the severity of ACS. Physicians should be guided rather by the clinical premises. There is an unacceptable long pain/door-to-balloon delay. Patients in this group should be subjected to urgent interventional treatment, similarly to patients with STEMI.
Authors and Affiliations
Leszek Majecki , Marek Dąbrowski
Keywords
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