Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Homa WaziriKristian Wachtell

Abstract

Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCX-NSTEACS do not have higher mortality compared with patients with LCX-ST...Continue Reading

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Citations

Jul 6, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Georg FuernauHolger Thiele
May 19, 2020·European Heart Journal. Acute Cardiovascular Care·Jakob JosiassenChristian Hassager
Feb 21, 2021·European Heart Journal. Acute Cardiovascular Care·Jakob JosiassenChristian Hassager
Sep 12, 2020·JACC. Cardiovascular Imaging·Makoto ArakiIk-Kyung Jang

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