title: Incidence, distribution, and prognostic impact of occluded culprit arteries among patients with non-ST-elevation acute coronary syndromes undergoing diagnostic angiography.
abstract: BACKGROUND
  Because acute occlusion of coronary arteries supplying the inferolateral myocardium frequently eludes standard 12-lead electrocardiogram (ECG) diagnosis, these patients may present as non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
  
  
  METHODS
  We examined culprit artery occlusion among 1,957 NSTE-ACS patients in the Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network trial who underwent diagnostic coronary angiography. We compared baseline characteristics, electrocardiographic findings, in-hospital treatment, and long-term outcomes between patients with and without occluded culprit arteries.
  
  
  RESULTS
  The culprit artery was occluded in 528 (27%) patients. Culprit lesions were more frequently identified in the inferolateral territory among patients with an occluded culprit artery (63%) compared with those with a nonoccluded artery (45%, P < .0001). Patients with an occluded culprit artery were younger, more often male, and more likely to have had a prior myocardial infarction. Despite similar in-hospital treatment, patients with an occluded culprit artery had larger infarcts (median peak creatine kinase-MB 4.3 vs 2.1 x upper limit of normal, P < .0001) and higher risk-adjusted 6-month mortality (hazard ratio 1.72, 95% CI 1.07-2.79).
  
  
  CONCLUSIONS
  More than 25% of NSTE-ACS patients had an occluded culprit artery on angiography. These patients may represent ST-segment elevation myocardial infarction equivalents; thus, improved early risk stratification techniques would help more rapidly triage these high-risk patients to an early invasive management strategy.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27705, USA. wang0085@mc.duke.edu
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Yuling
authors.initials: Y
authors.lastname: Fu
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: David J
authors.initials: DJ
authors.lastname: Moliterno
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe