Non ST-segment elevation myocardial infarction with total occlusion of the infarct related artery / Hala Hassan Mahmoud ; Supervised Mohammed Mahmoud Abdelghany , Yasser Yazied Abdelmonem , Emmanuel Fares Aziz

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background: -Total occlusion (TO) of the culprit coronary artery usually presents with STEMI. A subset of patients with TO present as NSTEMI. This may lead to delay in identification of these patients and further management. Aim: -We performed a study on NSTEMI patients with totally occluded culprit coronary artery to identify a peculiar clinical profile, specific electrocardiographic changes, laboratory or echocardiographic characteristics and whether they may have different in-hospital outcome. Methods: -Our study included 111 patients. Patients{u2019} demographics, co-morbidities, baseline laboratory values, admission ECG, echocardiography and coronary angiographic results were analyzed. Results: -A total of 20 (18.02%) patients had an occluded culprit coronary artery with a predominant RCA 50%. The majority of NSTEMI patients with TO were males (n=17, 85.0%) and presented by chest pain (n=13, 65.0%) and also had higher incidence of CV risk factors, such as hypertension (with p-value=0.376) and DM (with p-value=0.786) which are non-significant and CKD (with p-value = 0.044) which is significant. Their admission ECGs were of normal sinus rhythm with higher incidence of ST-segment depression (with p-value=0.046) and ST-segment elevation in lead aVR (with p-value = 0.026). On admission echocardiography, there was higher incidence of RWMA of the lateral and inferior walls (with p-value = 0.014 and p-value 0.022 respectively)

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