(O-T3) Occlusion Myocardial Infarction and Non ST Segment Elevation Acute Coronary Syndrome in Emergency Department

Objectives: This study aimed to evaluate the OMI rate and hospital outcomes in NSTE-ACS patients in ED.

Background: Acute coronary syndrome is one of the most important causes of mortality in the emergency department (ED), and early reperfusion reduces morbidity and mortality. Recently, the definition of myocardial infarction with occlusion has been made. Occlusion myocardial infarction (OMI) is defined as acute coronary occlusion or near occlusion with insufficient collateral circulation leading to downstream myocardial infarction.

Methods: This retrospective, single-center study included 2158 consecutive acute coronary syndrome who presented to the ED. Patients’ characteristics, laboratory results, and in-hospital death have been noted. Those who were taken to angiography after applying to the emergency department were evaluated as ACS. Patients with TIMI 0 and 1 according to their angiography reports were evaluated as OMI. Two groups were compared as the OMI group and those without OMI. OMI status was evaluated in NSTE-ACS patients, as STEMI patients underwent angiography in the early period.

Results: A total of 2158 patients with acute coronary syndrome were enrolled in the study. 648 (30%) of the patients were women. The median age was 63 [54-72] years. The most common complaints of the patients were chest pain (n=1690, 78.3%) and nausea (n=547, 25.3%). 43 patients (2%) were brought in as cardiac arrest. According to the initial ECG evaluations, 776 (36%) of the patients had STEMI, 859 (39.8%) NSTEMI and 523 (24.2%) UAP.
OMI detected in 234 (27.2%) of NSTEMI patients and 64 (12.2%) of the UAP patients. OMI was detected in 298 patients (21.6%) of all NSTE-ACS patients. 217 of those with OMI were male (72.8%), and those without OMI (65.8%) (p=0.022). Patients in the OMI group, compared to OMI negative group, had significantly higher troponin (p < 0.001), creatinine (p =0.011). In-hospital death were higher in the OMI group but this was not statistically significant (p=0.634).

Conclusions: In this study, the rates of NSTE-ACS patients with OMI were evaluated. Most of the NSTE-ACS patients are not evaluated angiographically in the early period, which may lead to increased morbidity. Although we did not evaluate ejection fraction in our study, we found that mortality was slightly higher in OMI patients.

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Funding (Optional): N/A