Author + information
- Pedro Pérez-Díaz1,
- Alfonso Jurado-Román1,
- Ignacio Sanchez-Perez1,
- María Thiscal López Lluva1,
- Ramón Maseda Uriza1,
- Jesus Piqueras-Flores1 and
- Fernando Lozano1
Left circumflex occlusion is underdiagnosed in most of reperfusion studies about Myocardial Infarction, due to its poor electrocardiographic expressiveness and late diagnosis. This late diagnosis leads to higher infarct size and time to opening of the artery.
Observational retrospective study including 628 coronary angiographies in a single university hospital between July 2016 and April 2017. We analyzed baseline and angiographic characteristics, clinical presentation, delay from diagnosis to emergency unit, cardiac biomarkers, electrocardiographic parameters and presentation of arrhythmias during admission.
293 patients (70.1% male; 67.2 ± 12.5 years) with acute coronary syndrome (ACS) were analyzed, of which left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were occluded in 12.5%, 5.5% and 17.2% respectively. 73% of cases with left circumflex occlusion presented as ST Segment Elevation Myocardial Infarction (STEMI) and 26% were initially diagnosed as Non-ST Segment Elevation Myocardial Infarction (NSTEMI). We found no differences in baseline characteristics comparing patients with Cx as the culprit artery with the others. Peak creatine phosphokinase was significantly higher in Cx occlusion than in RCA (1604.7 +- 909.6 UI/l vs 360.7 +- 338.7 UI/l, p=0.019) in NSTEMI. The most frequent ECG findings in patients with Cx occlusion were the combination “ST depression in V1-V4 leads and ST elevation in inferior leads” (26%). Mean time from symtoms onset to emergency unit was 310, 790 and 658 minutes in LAD, Cx and RCA respectively (p=0.007). We detected a higher rate of non-sustained ventricular tachycardia in Cx occlusions (3.2%, 28.6% and 17.9% respectively, p=0.017).
Cx occlusion was only responsible for 5.5% acute coronary syndromes (and 10.7% STEMI). The most frequent ECG abnormalities were ST depression of V1-V4 leads with ST elevation in inferior leads. Cx occlusions were initially diagnosed as NSTEMI in 26% of cases and these patients presented higher levels of CPK, longer delay from symptoms onset to arrival at the emergency department and a higher rate of non-sustained ventricular tachycardia.
CORONARY: Acute Coronary Syndromes