Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention: Insights From the CathPCI Registry.

R. Kherallah Syed Zaid Y. Assaf Angel Chen Marks G. Levine N. Kleiman M. Khalid Lorraine Mascarenhas Jing Liu Waleed T. Kayani Y. Birnbaum Daniel M. Wojdyla Rajesh V. Swaminathan Ali A. Denktas

Oct 2026 · JACC: Cardiovascular Interventions · Vol 19 19, pp. 2539-2551 · 1 citation · 26 references

Medicine

Abstract

Background

Patients may present with acute coronary occlusions (ACOs) without manifesting electrocardiographic criteria for ST-segment elevation myocardial infarction (STEMI).

Objectives

The aim of this study was to examine the incidence, clinical characteristics, and in-hospital outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) with ACO.

Methods

The study included patients with STEMI and NSTEMI in the CathPCI Registry who underwent percutaneous coronary intervention between April 1, 2018, and June 30, 2023. ACO was defined as 100% stenosis deemed acute. The cohort was stratified into STEMI (including STEMI equivalents), NSTEMI-ACO, and NSTEMI-no-ACO. The primary outcome was a composite of in-hospital stroke, myocardial infarction, or cardiovascular mortality. A sensitivity analysis with ACO defined as 100% acute occlusion or TIMI flow grade 0 or 1 in the culprit artery was performed.

Results

Of 1,198,544 patients, 26.1% had STEMI, 11.0% had NSTEMI-ACO (15% of whom had NSTEMI), and 62.9% had NSTEMI-no-ACO. Compared with those with NSTEMI-no-ACO, NSTEMI-ACO patients had more cardiogenic shock (9.0% STEMI vs 3.8% NSTEMI-ACO vs 1.9% NSTEMI-no-ACO; P < 0.001), ventricular arrhythmias (4.9% vs 2.0% vs 1.3%; P < 0.001), and in-hospital cardiac arrest (6.1% vs 2.7% vs 1.6%; P < 0.001). Patients with NSTEMI-ACO had a higher risk for the primary composite compared with those with NSTEMI-no-ACO (adjusted OR: 2.26; 95% CI: 2.18-2.34; P < 0.001) but a lower risk compared with those with STEMI (adjusted OR: 0.54; 95% CI: 0.52-0.56; P < 0.001). Using a definition of ACO including TIMI flow grade 0 or 1, NSTEMI-ACO accounted for 216,054 presentations (24.4% of NSTEMI). In-hospital outcomes were similarly worse compared with NSTEMI-no-ACO and better compared with STEMI.

Conclusions

ACO occurs in a substantial proportion of patients with NSTEMI and is associated with worse in-hospital outcomes relative to those with NSTEMI-no-ACO. Further studies of early identification and reperfusion practices for NSTEMI-ACO are warranted.

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