Incidence of Occluded Culprit Arteries and Impact of Coronary Collaterals on Outcome in Patients With NSTEMI

Study Overview
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Brief Summary
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It is assumed that patients with non-ST-elevation myocardial infarctions (NSTEMI) showing an infero- or posterolateral occluded culprit artery (OCA) during diagnostic angiography frequently elude standard 12-lead electrocardiogram diagnosis. In addition, coronary collaterals may have beneficial effects in patients with OCA.

Detailed Description
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We examined consecutive NSTEMI patients within 48 h of symptom onset. All patients underwent early invasive angiography plus optimal medical therapy. We compared baseline characteristics, procedural findings including analysis of TIMI-flow and collaterals using the Rentrop-classification, 30-day and 6-months major adverse cardiovascular events (MACE) in patients with and without totally OCA.

Official Title
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Substudy of the Leipzig Immediate Versus Early and Late Percutaneous Coronary Intervention Trial in NSTEMI - LIPSIA-NSTEMI TRIAL

Conditions
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NSTEMI

Intervention / Treatment
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* Procedure: percutaneous coronary intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age between 18 and 90 years, onset of angina pectoris at rest <24 h or crescendo angina in recent weeks with symptoms under minimal exertion or at rest lasting <24 h, elevated troponin T ≥0.03 µg/L and written informed consent. Exclusion Criteria: persistent angina, ST-segment elevation myocardial infarction (STEMI), hemodynamic instability including cardiogenic shock, oral anticoagulation therapy, contraindications for glycoprotein IIb/IIIa inhibitors, other disease with life expectancy <6 months, known coagulopathy, pregnancy, other suspected causes of troponin elevation as myocarditis, secondary to hypertensive crisis, or after cardiac decompensation, no ability to consent, and participation in another study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: occluded culprit artery<br>An occluded lesion was defined as a lesion with 100% stenosis or TIMI-flow grade 0 or 1. | Procedure: percutaneous coronary intervention<br>* early timing<br>* Other names: early invasive treatment strategy in NSTEMI;|
| Active Comparator: non-occluded culprit artery<br>A non-occluded lesion was defined as a lesion without 100% stenosis or TIMI-flow grade 0 or 1. | Procedure: percutaneous coronary intervention<br>* early timing<br>* Other names: early invasive treatment strategy in NSTEMI;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MACE | composite of death, reinfarction and readmission for unstable angina within 6 months after inclusion | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CK and CK-MB | Venous blood samples were taken at admission (baseline), and every 6 h subsequently for a period of 48 h. | 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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myocardial infarction, coronary occlusion, myocardial revascularization, collaterals, prognosis