ABSTRACT
BACKGROUND: Acute total occlusion (ATO) is diagnosed in a substantial proportion of patients with Non-ST-elevation myocardial infarction (NSTEMI). We compared procedural outcomes and long- term mortality in patients with ST-elevation myocardial infarction (STEMI) with NSTEMI with vs. without ATO. METHODS: We included patients with acute myocardial infarction undergoing invasive coronary angiography between 2004 and 2019 at our center. ATO was defined as TIMI 0-1 flow in the infarct-related artery or TIMI 2-3 flow with highly elevated peak troponin (>100-folds the upper reference limit). Association between presentation and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. RESULTS: From 2269 acute myocardial infarction patients (mean age 66 ± 13.2 years, 74% male), 664 patients with STEMI and 1605 patients with NSTEMI (471 [29.3%] with ATO) were included. ATO(+)NSTEMI had higher frequency of cardiogenic shock and no-reflow than ATO(-)NSTEMI with similar rates compared to STEMI patients (cardiogenic shock: 2.76 vs. 0.27 vs. 2.86%, p < 0.0001, p = 1; no-reflow: 4.03 vs. 0.18 vs. 3.17%, p < 0.0001, p = 0.54). ATO(+)NSTEMI and STEMI were associated with 60% and 55% increased incident mortality, as compared to ATO(-)NSTEMI (ATO(+)NSTEMI: 1.60[1.27-2.02], p < 0.0001, STEMI: 1.55[1.24-1.94], p < 0.0001). Likewise, left ventricular ejection fraction (48.5 ± 12.7 vs. 49.1±11 vs. 50.6 ± 11.8%, p = 0.5, p = 0.018) and global longitudinal strain (-15.2±-5.74 vs. -15.5±-4.84 vs. -16.3±-5.30%, p = 0.48, p = 0.016) in ATO(+)NSTEMI were comparable to STEMI but significantly worse than in ATO(-)NSTEMI. CONCLUSION: NSTEMI patients with ATO have unfavorable procedural outcomes, resulting in increased long-term mortality, resembling STEMI. Our findings suggest that the occlusion perspective provides more appropriate classification of acute myocardial infarction than differentiation into STEMI vs. NSTEMI.
