Predictors of total occlusion of the infarct-related artery in patients with acute Non-ST elevation myocardial infarction

Background/Aims : Some patients with non-ST elevation myocardial infarction (NSTEMI) have total occlusion of the infarct related artery (IRA) and may benefit from early invasive treatments. The aim of this study was to investigate the predictors of total occlusion of the IRA in patients with NSTEMI before coronary angiography. Methods : A total of 205 consecutive patients with NSTEMI (63.3±10.5 years, 123 males) who were admitted and underwent coronary angiogram from April 2005 to December 2006 at Chonnam National University Hospital were divided into two groups: group I (total occlusion of IRA: n=62, 61.1±13.3 years, 42 males) and group II (patent IRA: n=143, 64.2±11.3 years, 81 males). Clinical, biochemical and echocardiographic parameters on admission were compared between the groups. Results : A total occlusion of the IRA in patients with NSTEMI was observed in 62 (30.2%) patients most frequently in the left circumflex coronary artery. The predictive factors for total occlusion, according to the multivariate analysis, were prolonged duration of continuous chest pain (OR:9.67, 95% CI:1.59～80.6, p=0.03), a higher level of the creatine kinase-MB fraction (CK-MB) (OR:5.35, 95% CI:1.31～90.0, p=0.035) and fibrinogen (OR:6.73, 95% CI:1.48～50.2, p=0.043), and multiple leads with ST depression on the ECG (OR:4.78, 95% CI:1.22～41.9, p=0.048). Conclusions : Total occlusion of the IRA in patients with acute NSEMI is associated with a long duration of chest pain, high levels of CK-MB and fibrinogen, and ST changes in multiple ECG leads. (Korean J Med 74:271-280, 2008)