Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry)

W. Kyle Stribling, Michael C. Kontos, Antonio Abbate, Richard Cooke, George W. Vetrovec, David Dai, Emily Honeycutt, Tracy Y. Wang, Kapildeo Lotun

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50% of the time, potentially delaying treatment and resulting in worse outcomes. In contemporary practice, little is known about the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). We identified patients with myocardial infarction from April 2004 to June 2009 in the CathPCI Registry treated with percutaneous coronary intervention for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting. Logistic generalized estimating equation modeling was used to compare the outcomes, including in-hospital mortality between patients with STEMI and non-STEMI (NSTEMI) adjusting for differences in the baseline characteristics. Of the 27,711 patients with myocardial infarction and acute LCx territory occlusion, 18,548 (67%) presented with STEMI and 9,163 (33%) with NSTEMI. With the exception of a greater proportion of cardiac risk factors and cardiac history in the NSTEMI group, the demographic and baseline characteristics were clinically similar between the 2 groups, despite the statistical significance resulting from the large population. The patients with STEMI were more likely to have a proximal LCx culprit lesion (63% vs 27%, p <0.0001) and had greater risk-adjusted in-hospital mortality (odds ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002) compared to patients with NSTEMI. In conclusion, acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.

Original languageEnglish (US)
Pages (from-to)959-963
Number of pages5
JournalThe American journal of cardiology
Volume108
Issue number7
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Registries
Myocardial Infarction
Hospital Mortality
Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Vessels
Myocardium
Electrocardiography
History
Odds Ratio
Demography
Confidence Intervals
Mortality
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry). / Stribling, W. Kyle; Kontos, Michael C.; Abbate, Antonio; Cooke, Richard; Vetrovec, George W.; Dai, David; Honeycutt, Emily; Wang, Tracy Y.; Lotun, Kapildeo.

In: The American journal of cardiology, Vol. 108, No. 7, 01.10.2011, p. 959-963.

Research output: Contribution to journalArticle

Stribling, WK, Kontos, MC, Abbate, A, Cooke, R, Vetrovec, GW, Dai, D, Honeycutt, E, Wang, TY & Lotun, K 2011, 'Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry)', The American journal of cardiology, vol. 108, no. 7, pp. 959-963. https://doi.org/10.1016/j.amjcard.2011.05.027
Stribling, W. Kyle ; Kontos, Michael C. ; Abbate, Antonio ; Cooke, Richard ; Vetrovec, George W. ; Dai, David ; Honeycutt, Emily ; Wang, Tracy Y. ; Lotun, Kapildeo. / Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry). In: The American journal of cardiology. 2011 ; Vol. 108, No. 7. pp. 959-963.
@article{28d565a98690419991ea894a7019ce93,
title = "Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry)",
abstract = "Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50{\%} of the time, potentially delaying treatment and resulting in worse outcomes. In contemporary practice, little is known about the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). We identified patients with myocardial infarction from April 2004 to June 2009 in the CathPCI Registry treated with percutaneous coronary intervention for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting. Logistic generalized estimating equation modeling was used to compare the outcomes, including in-hospital mortality between patients with STEMI and non-STEMI (NSTEMI) adjusting for differences in the baseline characteristics. Of the 27,711 patients with myocardial infarction and acute LCx territory occlusion, 18,548 (67{\%}) presented with STEMI and 9,163 (33{\%}) with NSTEMI. With the exception of a greater proportion of cardiac risk factors and cardiac history in the NSTEMI group, the demographic and baseline characteristics were clinically similar between the 2 groups, despite the statistical significance resulting from the large population. The patients with STEMI were more likely to have a proximal LCx culprit lesion (63{\%} vs 27{\%}, p <0.0001) and had greater risk-adjusted in-hospital mortality (odds ratio 1.36, 95{\%} confidence interval 1.12 to 1.65, p = 0.002) compared to patients with NSTEMI. In conclusion, acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.",
author = "Stribling, {W. Kyle} and Kontos, {Michael C.} and Antonio Abbate and Richard Cooke and Vetrovec, {George W.} and David Dai and Emily Honeycutt and Wang, {Tracy Y.} and Kapildeo Lotun",
year = "2011",
month = "10",
day = "1",
doi = "10.1016/j.amjcard.2011.05.027",
language = "English (US)",
volume = "108",
pages = "959--963",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry)

AU - Stribling, W. Kyle

AU - Kontos, Michael C.

AU - Abbate, Antonio

AU - Cooke, Richard

AU - Vetrovec, George W.

AU - Dai, David

AU - Honeycutt, Emily

AU - Wang, Tracy Y.

AU - Lotun, Kapildeo

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50% of the time, potentially delaying treatment and resulting in worse outcomes. In contemporary practice, little is known about the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). We identified patients with myocardial infarction from April 2004 to June 2009 in the CathPCI Registry treated with percutaneous coronary intervention for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting. Logistic generalized estimating equation modeling was used to compare the outcomes, including in-hospital mortality between patients with STEMI and non-STEMI (NSTEMI) adjusting for differences in the baseline characteristics. Of the 27,711 patients with myocardial infarction and acute LCx territory occlusion, 18,548 (67%) presented with STEMI and 9,163 (33%) with NSTEMI. With the exception of a greater proportion of cardiac risk factors and cardiac history in the NSTEMI group, the demographic and baseline characteristics were clinically similar between the 2 groups, despite the statistical significance resulting from the large population. The patients with STEMI were more likely to have a proximal LCx culprit lesion (63% vs 27%, p <0.0001) and had greater risk-adjusted in-hospital mortality (odds ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002) compared to patients with NSTEMI. In conclusion, acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.

AB - Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50% of the time, potentially delaying treatment and resulting in worse outcomes. In contemporary practice, little is known about the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). We identified patients with myocardial infarction from April 2004 to June 2009 in the CathPCI Registry treated with percutaneous coronary intervention for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting. Logistic generalized estimating equation modeling was used to compare the outcomes, including in-hospital mortality between patients with STEMI and non-STEMI (NSTEMI) adjusting for differences in the baseline characteristics. Of the 27,711 patients with myocardial infarction and acute LCx territory occlusion, 18,548 (67%) presented with STEMI and 9,163 (33%) with NSTEMI. With the exception of a greater proportion of cardiac risk factors and cardiac history in the NSTEMI group, the demographic and baseline characteristics were clinically similar between the 2 groups, despite the statistical significance resulting from the large population. The patients with STEMI were more likely to have a proximal LCx culprit lesion (63% vs 27%, p <0.0001) and had greater risk-adjusted in-hospital mortality (odds ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002) compared to patients with NSTEMI. In conclusion, acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.

UR - http://www.scopus.com/inward/record.url?scp=80052720785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052720785&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2011.05.027

DO - 10.1016/j.amjcard.2011.05.027

M3 - Article

C2 - 21820644

AN - SCOPUS:80052720785

VL - 108

SP - 959

EP - 963

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 7

ER -