title: Left circumflex artery-related myocardial infarction: does ST elevation matter? Results from the Euro Heart Survey PCI registry.
abstract: OBJECTIVE
  Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction.
  
  
  RESULTS
  Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n=1100, 54.7%) were compared to those with LCX-related NSTEMI (n=910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P<0.001) or had been resuscitated (8.5 versus 2.7%, P<0.0001). TIMI 0-1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P<0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P=0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08-2.72, P<0.05).
  
  
  CONCLUSIONS
  Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI.
authors.affiliation: Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen, Germany; Universitätsklinik Gießen, Germany. Electronic address: bauer-timm@gmx.de.
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.forename: Franz
authors.initials: F
authors.lastname: Weidinger
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Jean
authors.initials: J
authors.lastname: Marco
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels; D003625:Data Collection; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Left circumflex artery; Non ST elevation myocardial infarction; Percutaneous coronary intervention; ST elevation myocardial infarction