الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The prevalence and significance of complete occlusion of the culprit artery in patients presenting with non ST-segment elevation myocardial infarction (NSTEMI) may be underestimated.
There are no standard methods for predicting Infarct related artery in NSTEMI, unlike STEMI, and there are no known factors predicting Total occlusion of the Infarct related artery in NSTEMI.
Approximately 25% of patients presented with NST-ACS have total occluded culprit artery as shown in many studies.
The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation in the issue of Identification of the culprit lesion in NSTE-ACS In order to characterize a coronary lesion as culprit on angiography, at least two of the following morphological features suggestive of acute plaque rupture should be present: intraluminal filling defects consistent with thrombus or plaque ulceration or plaque irregularity or dissection or impaired flow.
The aim of the study was to evaluate the in-hospital and midterm outcomes of early percutaneous coronary intervention (PCI) in Non ST Elevation Acute Coronary Syndrome with or without total occlusion of one of the main coronary arteries.
All patients were subjected to detailed history taking, clinical evaluation, ECG analysis, Echocardiography, laboratory investigations and assessing GRACE risk score at admission.
Coronary angiography and PCI procedure were described including pre-procedural preparation, PCI procedure details, materials used, intra-procedure complications and post-PCI management were also documented. Baseline SYNTAX score & residual SYNTAX score were also calculated.
Patients were put under observation to detect the occurrence of any in-hospital MACCE or other hemodynamic complications.
All the patients were followed for 6 months after the procedure by interviewing with the patients via telephone or the responsible physician to determine the clinical outcomes of the procedure.
The results of this study showed:
There is higher incidence of male patients in the totally occluded group with no statistically significant difference (87.5% vs. 77.8%, p=0.11). Patients in the non-totally occluded group was older than totally occluded group with no statistically difference (59.09 ± 9.686 vs. 56.54 ± 9.437, p=0.08).
There were significant higher incidence of DM in the non-total occluded vessel (49.5% vs. 32.1%, p=0.02) . There were tendency of higher incidence of hypertension in the non-total occluded group which was not statistically significant (62.9% vs. 50%, p=0.08).
Smoking is an important risk factor. 55.3% of the totally occluded group was current smokers and 16% were former smokers. In the non-totally occluded group 44.3% of the patients were current smokers and 7% were former smokers. It was statistically significant in totally occluded group (p=0.01)
There was significant higher level of cardiac enzymes with totally occluded group. Mean ejection fraction in totally occluded group is slightly lower than non-totally occluded group with no statistically significant difference (58.64± 7.44 vs. 59.19±7.616, p=0.344).
In the totally occluded group, LCX represented the culprit vessel in 55.4% of patients, RCA was the culprit in 23.2% and LAD was the culprit in 21.4% of the patients. In non-totally occluded group LAD represented the culprit vessel in 53.1% of patients, LCX was the culprit in 25.8 %, RCA was the culprit in 21.1% of the patients.
The in-hospital MACCE rate was 5.3% in totally occluded group. As regard other in-hospital complication, 8.9% of totally occluded group complicated with arrhythmia. 3.5% of patients developed HF, 5.4 % of patients developed bleeding.
The in-hospital MACCE rate was 1% in non-totally occluded group. As regard other in-hospital complication; 4.1% of patients developed HF, 1% of patients developed arrhythmias, 0.5% of patients developed bleeding. There were no significant differences between 2 groups (5.3% vs. 1 %, p=0.07) but there is higher significant level of arrhythmia with totally occluded group.
Six months follow up MACCE rate was 5.4% in totally occluded group. As regard other complication; in totally occluded group, 1.8% of patients developed HF, 3.6 % of patients developed minor bleeding.
Six months follow up MACCE rate was 4.6% in non-totally occluded group. As regard other complication, 1.5% of patients developed HF. There was no significant differences between 2 groups within 6 month follow up (5.4% vs. 4.6%, p=0.24)