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Background <p>The prevalence, characteristics, management, and long-term outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI) due to a completely occluded culprit coronary artery (NSTEMI-OMI) remain insufficiently characterised.</p> Methods <p>In this international multicentre study, consecutive patients with centrally adjudicated type I NSTEMI were classified as NSTEMI-OMI if they had a TIMI flow grade of 0 or 1 or grade 2 with severe coronary narrowing (&gt; 70%) and a high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500&#xa0;ng/L. Prospectively recorded chest pain characteristics, 12-lead ECG, serial hs-cTnT concentrations, time to coronary angiography/revascularisation, and 5-year mortality were compared in patients with NSTEMI-OMI versus other type I NSTEMI (NSTEMI-NOMI).</p> Results <p>Among 801 patients with type I NSTEMI (median age 68&#xa0;years, 22.2% female), 251 patients (31.3%) had NSTEMI-OMI. Patients with NSTEMI-OMI presented more often with persistent chest pain (56.1% vs. 37.9%, <i>p</i> &lt; 0.001), more often had ST-segment depression (34.3% vs. 23.0%, <i>p</i> &lt; 0.001), and exhibited higher and faster rising hs-cTnT concentrations. Time from admission to coronary angiography (median 7.2&#xa0;h [IQR 4.7, 21.8] vs. 19.6&#xa0;h [IQR 6.2, 27.9], <i>p</i> &lt; 0.001) and coronary revascularisation (median 8.2&#xa0;h [IQR 4.9, 24.0] vs. 22.0&#xa0;h [IQR 6.3, 46.1], <i>p</i> &lt; 0.001) were both significantly shorter in patients with NSTEMI-OMI versus NSTEMI-NOMI. Five-year mortality was comparable in patients with NSTEMI-OMI versus NSTEMI-NOMI (adjHR 1.13 [95% CI 0.78–1.63], <i>p</i> = 0.51).</p> Conclusion <p>One in three patients with type I NSTEMI had NSTEMI-OMI. These patients more often present with very high-risk clinical, ECG, and biomarker features and receive earlier invasive management. Likely related to the latter, 5-year mortality was similar between NSTEMI-OMI and NSTEMI-NOMI.</p> Graphical Abstract <p></p>

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Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome

  • 期刊论文

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  • 发表日期：

    2026年7月22日

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  • Lea Kirsten,
  • Pedro Lopez-Ayala,
  • Emel Kaplan,
  • Jasper Boeddinghaus,
  • Luca Koechlin,
  • Lourdes Herraiz-Recuenco,
  • Gabrielle Huré,
  • Karin Wildi,
  • Paolo Bima,
  • Jonas Glaeser,
  • Carlos C. Spagnuolo,
  • Luca Crisanti,
  • Òscar Miró,
  • Michael Christ,
  • Dagmar I. Keller,
  • Javier F. Martin-Sanchez,
  • Roland Bingisser,
  • Gregor Leibundgut,
  • Felix Mahfoud,
  • Ivo Strebel,
  • Christian Mueller,
  • Desiree Wussler,
  • Thomas Nestelberger,
  • Maria Rubini Gimenez,
  • Juliane Gehrke,
  • Jude Formambuh,
  • Tobias Zimmermann,
  • Christian Puelacher,
  • Ksenija Slankamena,
  • Danielle M. Gualandro,
  • Andreas Buser,
  • Eliska Potlukova,
  • Damian Kawecki,
  • Nicolas Geigy,
  • Katharina Rentsch,
  • Beata Morawiec,
  • Piotr Munzk,
  • Beatriz Lopez-Barbeito,
  • Gemma Martinez-Nadal,
  • Carolina Fuenzalida,
  • Sofia Calderón,
  • Esther Rodriguez Adrada,
  • Eva Ganovská,
  • Jiri Parenica,
  • Arnold von Eckardstein,
  • Isabel Campodarve,
  • Joachim Gea,
  • Christian Nickel

摘要

Background

The prevalence, characteristics, management, and long-term outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI) due to a completely occluded culprit coronary artery (NSTEMI-OMI) remain insufficiently characterised.

Methods

In this international multicentre study, consecutive patients with centrally adjudicated type I NSTEMI were classified as NSTEMI-OMI if they had a TIMI flow grade of 0 or 1 or grade 2 with severe coronary narrowing (> 70%) and a high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500 ng/L. Prospectively recorded chest pain characteristics, 12-lead ECG, serial hs-cTnT concentrations, time to coronary angiography/revascularisation, and 5-year mortality were compared in patients with NSTEMI-OMI versus other type I NSTEMI (NSTEMI-NOMI).

Results

Among 801 patients with type I NSTEMI (median age 68 years, 22.2% female), 251 patients (31.3%) had NSTEMI-OMI. Patients with NSTEMI-OMI presented more often with persistent chest pain (56.1% vs. 37.9%, p < 0.001), more often had ST-segment depression (34.3% vs. 23.0%, p < 0.001), and exhibited higher and faster rising hs-cTnT concentrations. Time from admission to coronary angiography (median 7.2 h [IQR 4.7, 21.8] vs. 19.6 h [IQR 6.2, 27.9], p < 0.001) and coronary revascularisation (median 8.2 h [IQR 4.9, 24.0] vs. 22.0 h [IQR 6.3, 46.1], p < 0.001) were both significantly shorter in patients with NSTEMI-OMI versus NSTEMI-NOMI. Five-year mortality was comparable in patients with NSTEMI-OMI versus NSTEMI-NOMI (adjHR 1.13 [95% CI 0.78–1.63], p = 0.51).

Conclusion

One in three patients with type I NSTEMI had NSTEMI-OMI. These patients more often present with very high-risk clinical, ECG, and biomarker features and receive earlier invasive management. Likely related to the latter, 5-year mortality was similar between NSTEMI-OMI and NSTEMI-NOMI.

Graphical Abstract