Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

中文翻译：

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非ST段抬高型心肌梗死急性冠脉综合征患者完全闭塞罪犯冠状动脉的发生率和影响

患有非ST段抬高型心肌梗死（NSTEMI）的患者被完全闭塞的罪犯冠状动脉的意义被低估了。该研究的目的是评估完全阻塞的罪犯动脉对NSTEMI急性冠状动脉综合征（ACS）患者的住院和6个月随访结果的发生率和影响。我们回顾性收集了2016年6月至2017年6月在我院就诊的500例NSTEMI患者的数据。所有患者均在就诊72小时内接受了PCI。我们排除了心源性休克，先前CABG和STEMI的患者。根据术前心肌梗死（TIMI）流程中的罪犯血管溶栓将患者分为两组。第1组TIMI血流共计0次冠状动脉阻塞，包括112例患者（占22.4％）。第2组，TIMI流1-3非完全阻塞，包括388名患者（77.6％）。第1组患者的吸烟发生率显着更高（p = 0.01），心脏酶水平显着更高（p <0.001），侧支明显更多（p <0.001），LCX和RCA作为罪魁祸首显着更多（p <0.01） ），而第2组患者的糖尿病发生率显着更高（p = 0.02），而LAD作为罪魁祸首则明显更多。两组在院内主要不良心脑血管事件（MACCE）方面无显着差异（完全闭塞组为5.3％，非完全闭塞组为1％，p = 0.07），但第1组患者院内心律失常的发生率明显更高（第1组为8.9％，第2组为1％，p = 0.007）。经过6个月的随访，随访6个月后，两组之间的MACCE差异无统计学意义（第1组为5.4％，第2组为4.6％，P = 0.24）。NSTEMI患者中有22.4％的罪犯动脉完全闭塞。在医院内或随访6个月后，阻塞的罪犯动脉的存在并未显着影响NSTEMI患者的临床结局，但与院内心律失常的发生率显着相关。