Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction

A systematic review and meta-Analysis

Abdur R. Khan, Harsh Golwala, Avnish Tripathi, Aref A. Bin Abdulhak, Chirag Bavishi, Haris Riaz, Vishnu Mallipedi, Ambarish Pandey, Deepak L. Bhatt

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-Analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. Methods and results Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and allcause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5%) patients had an occluded culprit artery with a predominant infero-lateral distribution (40% right coronary and 33% left circumflex artery). There was an increased risk of both MACE (short-Term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26%; medium-to long-Term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25%) and all-cause mortality (short-Term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41%; medium to long-Term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32%) with TO of the culprit artery. Conclusion Our meta-Analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.

Original languageEnglish (US)
Pages (from-to)3082-3089
Number of pages8
JournalEuropean heart journal
Volume38
Issue number41
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Meta-Analysis
Arteries
Mortality
Non-ST Elevated Myocardial Infarction
Acute Coronary Syndrome
Coronary Angiography
Stroke Volume
Angiography
Electrocardiography

Keywords

  • Acute total occlusion
  • Mortality
  • Non-ST-elevation acute coronary syndrome
  • NSTE-ACS
  • Systematic review

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction : A systematic review and meta-Analysis. / Khan, Abdur R.; Golwala, Harsh; Tripathi, Avnish; Bin Abdulhak, Aref A.; Bavishi, Chirag; Riaz, Haris; Mallipedi, Vishnu; Pandey, Ambarish; Bhatt, Deepak L.

In: European heart journal, Vol. 38, No. 41, 01.01.2017, p. 3082-3089.

Research output: Contribution to journalArticle

Khan, AR, Golwala, H, Tripathi, A, Bin Abdulhak, AA, Bavishi, C, Riaz, H, Mallipedi, V, Pandey, A & Bhatt, DL 2017, 'Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: A systematic review and meta-Analysis', European heart journal, vol. 38, no. 41, pp. 3082-3089. https://doi.org/10.1093/eurheartj/ehx418
Khan, Abdur R. ; Golwala, Harsh ; Tripathi, Avnish ; Bin Abdulhak, Aref A. ; Bavishi, Chirag ; Riaz, Haris ; Mallipedi, Vishnu ; Pandey, Ambarish ; Bhatt, Deepak L. / Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction : A systematic review and meta-Analysis. In: European heart journal. 2017 ; Vol. 38, No. 41. pp. 3082-3089.
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abstract = "Aims Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-Analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. Methods and results Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and allcause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5{\%}) patients had an occluded culprit artery with a predominant infero-lateral distribution (40{\%} right coronary and 33{\%} left circumflex artery). There was an increased risk of both MACE (short-Term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26{\%}; medium-to long-Term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25{\%}) and all-cause mortality (short-Term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41{\%}; medium to long-Term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32{\%}) with TO of the culprit artery. Conclusion Our meta-Analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.",
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author = "Khan, {Abdur R.} and Harsh Golwala and Avnish Tripathi and {Bin Abdulhak}, {Aref A.} and Chirag Bavishi and Haris Riaz and Vishnu Mallipedi and Ambarish Pandey and Bhatt, {Deepak L.}",
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T1 - Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction

T2 - A systematic review and meta-Analysis

AU - Khan, Abdur R.

AU - Golwala, Harsh

AU - Tripathi, Avnish

AU - Bin Abdulhak, Aref A.

AU - Bavishi, Chirag

AU - Riaz, Haris

AU - Mallipedi, Vishnu

AU - Pandey, Ambarish

AU - Bhatt, Deepak L.

PY - 2017/1/1

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N2 - Aims Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-Analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. Methods and results Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and allcause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5%) patients had an occluded culprit artery with a predominant infero-lateral distribution (40% right coronary and 33% left circumflex artery). There was an increased risk of both MACE (short-Term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26%; medium-to long-Term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25%) and all-cause mortality (short-Term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41%; medium to long-Term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32%) with TO of the culprit artery. Conclusion Our meta-Analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.

AB - Aims Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-Analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. Methods and results Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and allcause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5%) patients had an occluded culprit artery with a predominant infero-lateral distribution (40% right coronary and 33% left circumflex artery). There was an increased risk of both MACE (short-Term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26%; medium-to long-Term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25%) and all-cause mortality (short-Term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41%; medium to long-Term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32%) with TO of the culprit artery. Conclusion Our meta-Analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.

KW - Acute total occlusion

KW - Mortality

KW - Non-ST-elevation acute coronary syndrome

KW - NSTE-ACS

KW - Systematic review

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