title: Impact of occluded culprit arteries on long-term clinical outcome in patients with non-ST-elevation myocardial infarction: 48-month follow-up results in the COREA-AMI Registry.
abstract: BACKGROUND
  The prognostic impact of occluded culprit arteries in non-ST-elevation myocardial infarction (NSTEMI) patients beyond 12 months has not been investigated.
  
  
  OBJECTIVE
  The impact of occluded culprit arteries on a composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) in patients who presented with NSTEMI was investigated during a 48-month follow-up using propensity-score (PS) matching.
  
  
  METHODS
  A total of 2,878 NSTEMI patients in the COREA-AMI (COnvergent REgistry of cAtholic and chonnAm university for Acute MI) Registry were classified according to the angiographic flow of culprit arteries (occlusion [OC], n = 1,070; nonocclusion, n = 1,808). After PS matching, the incidence of the primary end-point, a composite of CD, RMI, and TVR was compared.
  
  
  RESULTS
  The median follow-up duration was 47.3 months (IQR 32.7-66.2). In the PS-matched population, the 48-month cumulative rates of the primary end-point (27.5% vs. 17.9%, P < 0.001) and each event were higher in the OC group (CD: 9.0% vs. 5.4%, RMI: 16.3% vs. 9.4%, TVR: 10.5% vs. 5.6%, respectively, P < 0.05). In multivariate Cox regression analysis, occluded culprit arteries showed the significant statistical impact on the primary end-point (HR 1.689 [1.385-2.059], P < 0.001) and each event (CD: 1.736 [1.218-2.475], RMI: 1.918 [1.468-2.505], TVR: 2.042 [1.453-2.869], respectively, P < 0.05). Furthermore, in the 12-month landmark analysis, occluded culprit arteries were still associated with higher risk of primary end-point beyond 12 months (P < 0.001).
  
  
  CONCLUSIONS
  Occluded culprit arteries were independently associated with the higher risk of CD, RMI, and TVR in NSTEMI patients during the 48-month follow-up.
authors.affiliation: Cardiovascular Center, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Shin
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Hwang
authors.forename: Hun-Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Seok Min
authors.initials: SM
authors.lastname: Seo
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Pum-Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D009204:Myocardial Revascularization; D011379:Prognosis; D012008:Recurrence; D012042:Registries