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Culprit plaque location within left circumflex coronary artery predicts clinical outcome in patients experiencing acute coronary syndromes with percutaneous coronary intervention — data from ORPKI registry

Michał Chyrchel12, Zbigniew Siudak3, Łukasz Rzeszutko12, Jan Roczniak4, Marcin Piechocki4, Wojciech Koziołek4, Krzysztof Piotr Malinowski5, Rafał Januszek12, Stanisław Bartuś12, Andrzej Surdacki12
DOI: 10.33963/KP.a2022.0150
·
Pubmed: 35724333
Affiliations
  1. Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
  2. 2nd Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  3. Faculty of Medicine and Health Sciences, Collegium Medicum Jan Kochanowski University in Kielce, Kielce, Poland
  4. Student Scientific Group at the 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  5. Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland

open access

Online first
Original article
Published online: 2022-06-20

Abstract

BACKGROUND: The left circumflex (Cx) artery is the most challenging of coronary branches in terms of diagnostics because the clinical presentation and electrocardiography (ECG) results do not always suggest critical occlusion despite its presence. Therefore, it is important to determine the factors contributing to the clinical manifestation and outcome, such as culprit location.

AIMS: To determine the relation between the location of the culprit plaque and clinical outcomes in the LCx artery.

METHODS: Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) concerning percutaneous coronary intervention (PCI) procedures have been extracted and analyzed using appropriate statistical tests.

RESULTS: Patients with proximal occlusion received a worse grade using the Killip score. Patients with thrombolysis in myocardial infarction (TIMI) score 0 presented worse clinical presentation in each of the occlusion locations. Periprocedural cardiac arrest and death rate was the highest among patients with proximal Cx occlusion. Death rate among patients with proximal occlusion and non ST segment elevation myocardial infarction (NSTEMI) was greater than among patients with distal occlusion and ST segment elevation myocardial infarction (STEMI).

CONCLUSIONS: Among patients with proximal occlusions of the Cx artery and TIMI 0 grade flow in initial angiogram, a STEMI-like approach should be undertaken apart from initial ECG findings. This is driven by a higher rate of critical and fatal complications such as cardiac arrest and periprocedural death. Fatal complications occur more often in patients with proximal occlusion of Cx than in medial or distal occlusion. Grade IV according to the Killip score can suggest proximal culprit location.

Abstract

BACKGROUND: The left circumflex (Cx) artery is the most challenging of coronary branches in terms of diagnostics because the clinical presentation and electrocardiography (ECG) results do not always suggest critical occlusion despite its presence. Therefore, it is important to determine the factors contributing to the clinical manifestation and outcome, such as culprit location.

AIMS: To determine the relation between the location of the culprit plaque and clinical outcomes in the LCx artery.

METHODS: Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) concerning percutaneous coronary intervention (PCI) procedures have been extracted and analyzed using appropriate statistical tests.

RESULTS: Patients with proximal occlusion received a worse grade using the Killip score. Patients with thrombolysis in myocardial infarction (TIMI) score 0 presented worse clinical presentation in each of the occlusion locations. Periprocedural cardiac arrest and death rate was the highest among patients with proximal Cx occlusion. Death rate among patients with proximal occlusion and non ST segment elevation myocardial infarction (NSTEMI) was greater than among patients with distal occlusion and ST segment elevation myocardial infarction (STEMI).

CONCLUSIONS: Among patients with proximal occlusions of the Cx artery and TIMI 0 grade flow in initial angiogram, a STEMI-like approach should be undertaken apart from initial ECG findings. This is driven by a higher rate of critical and fatal complications such as cardiac arrest and periprocedural death. Fatal complications occur more often in patients with proximal occlusion of Cx than in medial or distal occlusion. Grade IV according to the Killip score can suggest proximal culprit location.

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Keywords

culprit lesion, left circumflex artery, acute coronary syndromes, clinical outcomes, Killip classification

About this article
Title

Culprit plaque location within left circumflex coronary artery predicts clinical outcome in patients experiencing acute coronary syndromes with percutaneous coronary intervention — data from ORPKI registry

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-06-20

Page views

83

Article views/downloads

26

DOI

10.33963/KP.a2022.0150

Pubmed

35724333

Keywords

culprit lesion
left circumflex artery
acute coronary syndromes
clinical outcomes
Killip classification

Authors

Michał Chyrchel
Zbigniew Siudak
Łukasz Rzeszutko
Jan Roczniak
Marcin Piechocki
Wojciech Koziołek
Krzysztof Piotr Malinowski
Rafał Januszek
Stanisław Bartuś
Andrzej Surdacki

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