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  • Title: Left circumflex artery-related myocardial infarction: does ST elevation matter? Results from the Euro Heart Survey PCI registry.
    Author: Bauer T, Gitt AK, Hochadel M, Möllmann H, Nef H, Weidinger F, Zahn R, Hamm CW, Marco J, Zeymer U.
    Journal: Int J Cardiol; 2013 Oct 15; 168(6):5239-42. PubMed ID: 23998547.
    Abstract:
    BACKGROUND/OBJECTIVES: Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction. METHODS AND RESULTS: Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n=1100, 54.7%) were compared to those with LCX-related NSTEMI (n=910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P<0.001) or had been resuscitated (8.5 versus 2.7%, P<0.0001). TIMI 0-1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P<0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P=0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08-2.72, P<0.05). CONCLUSIONS: Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI.
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