Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance

Homa Waziri; Erik Jørgensen; Henning Kelbæk; Emil L. Fosbøl; Frantz Pedersen; Ulrik M Mogensen; Thomas A. Gerds; Lars Køber; Kristian Wachtell

doi:10.4244/EIJY15M09_04

Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance

Homa Waziri, Erik Jørgensen, Henning Kelbæk, Emil L. Fosbøl, Frantz Pedersen, Ulrik M Mogensen, Thomas A. Gerds, Lars Køber, Kristian Wachtell

6 Citations (Scopus)

Abstract

Aims: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. Methods and results: From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. Conclusions: The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCXNSTEACS do not have higher mortality compared with patients with LCX-STEMI or NSTEACS with lesions in other coronary territories.

Original language	English
Journal	EuroIntervention
Volume	12
Issue number	4
Pages (from-to)	441-448
Number of pages	8
ISSN	1774-024X
DOIs	https://doi.org/10.4244/EIJY15M09_04
Publication status	Published - Jul 2016

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@article{3ff3ee062f194b368c5debd14573f59b,

title = "Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance",

abstract = "Aims: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. Methods and results: From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. Conclusions: The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCXNSTEACS do not have higher mortality compared with patients with LCX-STEMI or NSTEACS with lesions in other coronary territories.",

author = "Homa Waziri and Erik J{\o}rgensen and Henning Kelb{\ae}k and Fosb{\o}l, {Emil L.} and Frantz Pedersen and Mogensen, {Ulrik M} and Gerds, {Thomas A.} and Lars K{\o}ber and Kristian Wachtell",

note = "PMID: 26348675",

year = "2016",

month = jul,

doi = "10.4244/EIJY15M09_04",

language = "English",

volume = "12",

pages = "441--448",

journal = "EuroIntervention",

issn = "1774-024X",

publisher = "Europa Digital & Publishing",

number = "4",

}

TY - JOUR

T1 - Acute myocardial infarction and lesion location in the left circumflex artery

T2 - importance of coronary artery dominance

AU - Waziri, Homa

AU - Jørgensen, Erik

AU - Kelbæk, Henning

AU - Fosbøl, Emil L.

AU - Pedersen, Frantz

AU - Mogensen, Ulrik M

AU - Gerds, Thomas A.

AU - Køber, Lars

AU - Wachtell, Kristian

N1 - PMID: 26348675

PY - 2016/7

Y1 - 2016/7

N2 - Aims: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. Methods and results: From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. Conclusions: The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCXNSTEACS do not have higher mortality compared with patients with LCX-STEMI or NSTEACS with lesions in other coronary territories.

AB - Aims: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. Methods and results: From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included. LCX was the culprit in 25% of NSTEACS and 14% of STEMIs (p<0.001). LCX lesions presented predominantly as STEMI in left dominant coronary arteries compared with NSTEACS (46% vs. 30%, p<0.001). Higher 30-day mortality was found in LCX-STEMI compared with LCX-NSTEACS (HR 7.9, 95% CI: 3.2-19.7, p<0.001) with no difference in long-term mortality (HR 0.9, 95% CI: 0.7-1.2, p=0.5). LCX-NSTEACS were not associated with higher mortality compared with other NSTEACS lesions. Conclusions: The 12-lead ECG seems sufficient for triage of patients with LCX lesions as a majority of patients with a large LCX due to a dominant left coronary artery present as STEMI. Patients with LCXNSTEACS do not have higher mortality compared with patients with LCX-STEMI or NSTEACS with lesions in other coronary territories.

UR - http://www.ncbi.nlm.nih.gov/pubmed/26348675

U2 - 10.4244/EIJY15M09_04

DO - 10.4244/EIJY15M09_04

M3 - Journal article

C2 - 26348675

SN - 1774-024X

VL - 12

SP - 441

EP - 448

JO - EuroIntervention

JF - EuroIntervention

IS - 4

ER -

Acute myocardial infarction and lesion location in the left circumflex artery: importance of coronary artery dominance

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