Abstract 17241: Single Vessel Disease With Acute Myocardial Infarction and Lesion Location in the Left Circumflex Artery
ST-elevation myocardial infarction (STEMI) is associated with impaired prognosis compared to non-ST-elevation acute coronary syndrome (NSTEACS). We assessed the hypothesis, that due to the limitations of the 12-lead ECG in locating STEMI in the circumflex coronary artery (Cx), these lesions may often be classified as NSTEACS with unclear effect on prognosis.
Methods: From the Eastern Danish Heart Registry 3,632 NSTEACS and 3,907 STEMI one-vessel disease patients (consecutive from1998-2011) who underwent angiography were included. Cox analysis was used to compare mortality in Cx-NSTEACS with Cx-STEMI. Mortality in Cx culprit lesions was also compared with culprit lesions in left anterior descendens (LAD) and right coronary artery (RCA) in NSTEACS and STEMI, respectively.
Results: Cx was the culprit lesion in 897 NSTEACS (24.7%) and 525 STEMI (13.4%, p<0.001) patients. Cx-NSTEACS patients were older (62 vs. 60 years, p<0.01), frequently women, with dyslipidemia, hypertension, peripheral artery disease (all p<0.01) and diabetes (p=0.012) compared to those with Cx-STEMI.
There was a significantly higher mortality in Cx-STEMI vs. Cx-NSTEACS (hazard ratio [HR] = 9.0, 95% CI 3.7-22.3, p<0.001), LAD-STEMI vs. LAD-NSTEACS ((HR 5.2, 95% CI 3.0 - 8.9, p<0.001)) and RCA-STEMI vs. RCA-NSTEACS (HR 5.2, 95% CI 2.6 - 10.2, p <0.001) during the first 30 days. There was no difference in the long-term (up to 12-years) mortality in Cx, LAD or RCA lesions between STEMI and NSTEACS. Among both STEMI and NSTEACS patients, we observed no difference in the long-term mortality according to lesion location (Figure 1).
Conclusions: In conclusion, Cx culprit lesions are more common in NSTEACS than in STEMI. Cx-NSTEACS patients do not have a higher short- or long-term mortality than Cx-STEMI or other NSTEACS patients with culprit lesions in other coronary territories. STEMI patients have a similar long-term mortality regardless of the culprit artery.
- © 2013 by American Heart Association, Inc.