Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-Segment elevation

Aaron M. From, Patricia Best, Ryan J. Lennon, Charanjit S. Rihal, Abhiram Prasad

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Acute occlusion of the left circumflex (LC) artery can be difficult to diagnose. The aim of the present study was to assess the incidence of LC occlusion in patients with acute myocardial infarction (AMI) requiring percutaneous coronary intervention (PCI), the frequency of ST-segment versus nonST-segment elevation presentation among them, and to correlate the electrocardiographic findings with the outcomes. The clinical characteristics and outcomes of consecutive patients from November 2001 through December 2007 with AMI within 7 days before PCI of a single acutely occluded culprit vessel were included in the present analysis. Of the 1,500 patients, the culprit lesion was located in the right coronary artery, left anterior descending artery, or LC artery in 44.7%, 35.8%, and 19.5% of patients, respectively. Of the 1,500 patients, 72% presented with ST-segment elevation AMI, but only 43% were patients with a LC lesion (n = 127). PCI was significantly less likely (80%, 83%, and 70% for right coronary, left anterior descending, and LC artery, respectively; p <0.001) to be performed within 24 hours for LC occlusions than for occlusions in the other territories. Among those with a nonST-segment elevation AMI, the highest post-PCI troponin levels were in patients with a LC artery occlusion (median 1.4, 1.3, and 2.5 ng/ml; p <0.001). No significant difference was found in the in-hospital mortality (4.4%, 7.4%, and 6.5%; p = 0.66) or major adverse cardiovascular event (9.2%, 13.9%, and 11.6%; p = 0.53) rates for right, left anterior descending, and LC occlusions, respectively. In conclusion, our results have demonstrated that in clinical practice, the LC artery is the least frequent culprit vessel among patients treated invasively for AMI. Patients with LC occlusion are less likely to present with ST-segment elevation AMI and have emergency PCI. The study results suggest that detection of these patients has been suboptimal, highlighting the need to improve the diagnostic approach toward the detection of an acutely occluded LC artery.

Original languageEnglish (US)
Pages (from-to)1081-1085
Number of pages5
JournalAmerican Journal of Cardiology
Volume106
Issue number8
DOIs
StatePublished - Oct 15 2010

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Arteries
Myocardial Infarction
Percutaneous Coronary Intervention
Troponin
Hospital Mortality
Coronary Vessels
Emergencies
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-Segment elevation. / From, Aaron M.; Best, Patricia; Lennon, Ryan J.; Rihal, Charanjit S.; Prasad, Abhiram.

In: American Journal of Cardiology, Vol. 106, No. 8, 15.10.2010, p. 1081-1085.

Research output: Contribution to journalArticle

From, Aaron M. ; Best, Patricia ; Lennon, Ryan J. ; Rihal, Charanjit S. ; Prasad, Abhiram. / Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-Segment elevation. In: American Journal of Cardiology. 2010 ; Vol. 106, No. 8. pp. 1081-1085.
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abstract = "Acute occlusion of the left circumflex (LC) artery can be difficult to diagnose. The aim of the present study was to assess the incidence of LC occlusion in patients with acute myocardial infarction (AMI) requiring percutaneous coronary intervention (PCI), the frequency of ST-segment versus nonST-segment elevation presentation among them, and to correlate the electrocardiographic findings with the outcomes. The clinical characteristics and outcomes of consecutive patients from November 2001 through December 2007 with AMI within 7 days before PCI of a single acutely occluded culprit vessel were included in the present analysis. Of the 1,500 patients, the culprit lesion was located in the right coronary artery, left anterior descending artery, or LC artery in 44.7{\%}, 35.8{\%}, and 19.5{\%} of patients, respectively. Of the 1,500 patients, 72{\%} presented with ST-segment elevation AMI, but only 43{\%} were patients with a LC lesion (n = 127). PCI was significantly less likely (80{\%}, 83{\%}, and 70{\%} for right coronary, left anterior descending, and LC artery, respectively; p <0.001) to be performed within 24 hours for LC occlusions than for occlusions in the other territories. Among those with a nonST-segment elevation AMI, the highest post-PCI troponin levels were in patients with a LC artery occlusion (median 1.4, 1.3, and 2.5 ng/ml; p <0.001). No significant difference was found in the in-hospital mortality (4.4{\%}, 7.4{\%}, and 6.5{\%}; p = 0.66) or major adverse cardiovascular event (9.2{\%}, 13.9{\%}, and 11.6{\%}; p = 0.53) rates for right, left anterior descending, and LC occlusions, respectively. In conclusion, our results have demonstrated that in clinical practice, the LC artery is the least frequent culprit vessel among patients treated invasively for AMI. Patients with LC occlusion are less likely to present with ST-segment elevation AMI and have emergency PCI. The study results suggest that detection of these patients has been suboptimal, highlighting the need to improve the diagnostic approach toward the detection of an acutely occluded LC artery.",
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