Abstract
Background
Myocardial infarction (MI) may be classified as ST‐elevation MI (STEMI) or non‐ST‐elevation MI (NSTEMI). There is little data regarding the relationship between the infarct related artery (IRA), clinical characteristics of the patients, and the ST deviation pattern (ie, STEMI or NSTEMI).
Hypothesis
There is a predilection of any coronary artery to a particular ST deviation pattern of acute MI.
Methods
We reviewed our institutional database and selected patients who presented with an acute MI and underwent coronary angiography within 7 days of admission. The analysis included 830 patients of whom 563 had STEMI and 267 had NSTEMI. The culprit lesion was defined by reviewing each patient's angiographic report, electrocardiogram, and echocardiogram. TIMI flow rate was determined.
Results
The IRA in STEMI was most frequently the left anterior descending coronary artery (LAD) followed by the right coronary artery (RCA) and then the left circumflex coronary artery (LCX), a statistically significant difference. In patients with NSTEMI there were no significant differences in IRA. Patients with STEMI and LCX as the IRA were significantly younger and had a higher percentage of TIMI grade 3 flow then patients with STEMI and LAD or RCA as IRAs. These differences were not noted in patients with NSTEMI regardless of IRA.
Conclusions
In STEMI there were significant differences in age and TIMI flow depending on the IRA. These findings were not demonstrated in patients with NSTEMI. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
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References
- 1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST‐elevation myocardial infarction. J Am Coll Cardiol 2004; 44: e1–e211. [DOI] [PubMed] [Google Scholar]
- 2. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/ non‐ST‐elevation myocardial infarction. J Am Coll Cardiol 2007; 50: e1–e157. [DOI] [PubMed] [Google Scholar]
- 3. Kuch B, von Scheidt W, Kling B, Heier M, Hoermann A, Meisinger C. Characteristics and outcome of patients with acute myocardial infarction according to presenting electrocardiogram (from the MONICA/KORA Augsburg Myocardial Infarction Registry). Am J Cardiol 2007; 100: 1056–1060. [DOI] [PubMed] [Google Scholar]
- 4. Terkelsen CJ, Lassen JF, Nørgaard BL, et al. Mortality rates in patients with ST‐elevation vs. non‐ST‐elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J 2005; 26: 18–26. [DOI] [PubMed] [Google Scholar]
- 5. Rott D, Weiss A, Chajek‐Shaul T, Leibowitz D. ST deviation patterns in recurrent myocardial infarctions. Am J Cardiol 2006; 98: 10–13. [DOI] [PubMed] [Google Scholar]
- 6. Leibowitz D, Planer D, Weiss T, Rott D. Seasonal variation in myocardial infarction is limited to patients with ST‐elevations on admission. Chronobiol Int 2007; 24: 1241–1247. [DOI] [PubMed] [Google Scholar]
- 7. Montalescot G, Dallongeville J, Van Belle E, et al. STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry). Eur Heart J 2007; 28: 1409–1417. [DOI] [PubMed] [Google Scholar]
- 8. Gheeraert PJ, Henriques JP, De Buyzere ML, et al. Out‐of‐hospital ventricular fibrillation in patients with acute myocardial infarction: coronary angiographic determinants. J Am Coll Cardiol 2000; 35: 144–150. [DOI] [PubMed] [Google Scholar]
- 9. DeWood MA, Spores J, Notske R, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303: 897–902. [DOI] [PubMed] [Google Scholar]
- 10. DeWood MA, Spores J, Hensley GR, et al. Coronary arteriographic findings in acute transmural myocardial infarction. Circulation 1983; 68: I39–49. [PubMed] [Google Scholar]
- 11. DeWood MA, Stifter WF, Simpson CS, et al. Coronary arteriographic findings soon after non‐Q‐wave myocardial infarction. N Engl J Med 1986; 315: 417–423. [DOI] [PubMed] [Google Scholar]
- 12. Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI‐3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104: 636–641. [DOI] [PubMed] [Google Scholar]
- 13. Stone GW, Brodie BR, Griffin JJ, et al. Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in‐hospital and 30‐day results of the PAMI stent pilot trial. Primary Angioplasty in Myocardial Infarction Stent Pilot Trial Investigators. J Am Coll Cardiol 1998; 31: 23–30. [DOI] [PubMed] [Google Scholar]
- 14. Zhao XQ, Theroux P, Snapinn SM, Sax FL. Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non‐Q‐wave myocardial infarction. Angiographic results from the PRISM‐PLUS trial (Platelet receptor inhibition for ischemic syndrome management in patients limited by unstable signs and symptoms). PRISM‐PLUS Investigators. Circulation 1999; 100: 1609–1615. [DOI] [PubMed] [Google Scholar]
- 15. Lowe GD, Rumley A, Woodward M, et al. Epidemiology of coagulation factors, inhibitors and activation markers: the Third Glasgow MONICA Survey. I. Illustrative reference ranges by age, sex and hormone use. Br J Haematol 1997; 97: 775–784. [DOI] [PubMed] [Google Scholar]