SummarySome patients with non-ST-elevation myocardial infarction (NSTEMI) have a total occlusive infarct-related artery. However, the long-term prognosis of these patients is uncertain, particularly for those who underwent an early invasive strategy.The aim of this study was to determine the clinical impact of total occlusion (TO) of an infarct-related artery (IRA) in these patients.A total of 2,094 patients with NSTEMI who underwent an early invasive strategy with percutaneous coronary intervention (PCI) in the Korea Acute MI Registry (KAMIR) were analyzed (TO group; 665 patients, and non-TO group; 1,429 patients).In-hospital and one-year clinical outcomes were compared between the two groups. The left circumflex (42.9%) and right coronary artery (31.9%) were the major IRA in the TO group, while the left anterior descending artery was more common as an IRA in the non-TO group (44.1%). In-hospital complications including death and cardiogenic shock occurred frequently in the TO group. Also, the rates of one-month and 12-month adverse cardiac outcomes were higher in the TO group. In the Cox-proportional hazard model, TO in IRA predicted 12-month all-cause death.In conclusion, NSTEMI patients with TO in IRA showed worse short-and long-term clinical outcomes compared with those of non-TO patients. (Int Heart J 2012; 53: 160-164) Key words: Non-ST-elevation myocardial infarction, Total occlusion, Percutaneous coronary intervention A mong patients with acute myocardial infarction (AMI), non-ST-elevation MI (NSTEMI) is a heterogenous group in aspects of diagnosis, treatment, and timing of percutaneous coronary intervention (PCI). It is difficult to decide the optimal timing of PCI in patients with NSTEMI because of various clinical settings. However, an early invasive strategy with PCI gives better clinical and angiographic results in high risk patients with NSTEMI than conservative management or late PCI. 1,2) Generally, more than 50% of patients diagnosed as STE-MI are known to have total occlusion (TO) of an infarct-related artery (IRA).2) However, it is difficult to predict TO in patients with NSTEMI. One study regarding this issue revealed that the probability of TO in patients with NSTEMI was proportional to the time from symptoms to the diagnostic coronary angiogram.3) This finding is perhaps associated with a progression of nonocclusion to occlusion in IRA with time. In 2 recent studies, the proportion of TO of culprit artery in patients with NSTEMI was about one quarter, and TO was associated with larger infarcts and worse clinical outcomes. 4,5) Therefore, we assessed the clinical characteristics, angiographic findings, and long-term clinical outcomes in patients with NSTEMI having TO of the culprit artery in the largescaled Korea AMI Registry (KAMIR), which should provide valuable information about this issue. MethodsStudy design and populations: A total of 2,094 patients in the KAMIR from November 2005 to January 2008 were included in the present study. The KAMIR is a prospective, observational, multicente...

The present study aimed to investigate the clinical characteristics and 1-year outcomes of acute myocardial infarction (AMI) patients without significant stenosis on a coronary angiogram comparison with the clinical characteristics and outcomes of patients with significant coronary artery stenosis. A total of 1,220 patients with AMI were retrospectively classified into Group I (≥50% diameter stenosis, n=1,120) and Group II (<50%, n=100). Group II was further divided into two subgroups according to the underlying etiology: cryptogenic (Group II-a, n=54) and those with possible causative factors (Group II-b, n=46). Patients in Group II were younger, were more likely to be women, and were less likely to smoke and to have diabetes mellitus than were patients in Group I. The levels of cardiac enzymes, LDL-cholesterol levels, and the apo-B/A1 ratio were lower in Group II. However, 1-month and 12-month rates of major adverse cardiac events (MACE) were not significantly different between the two groups. The Group II-b subgroup comprised 29 patients with vasospasm, 11 with myocardial bridge, and 6 with spontaneous thrombolysis. Left ventricular ejection fraction and creatinine clearance were lower and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were higher in Group II-a than in Group II-b. However, outcomes including MACE and mortality at 12 months were not significantly different between the two subgroups. The 1-year outcomes of patients in Group II were similar to those of patients in Group I. The clinical outcomes in Group II-a were also similar to those of Group II-b, although the former group showed higher levels of NT-proBNP and hs-CRP.

Drug-eluting stents (DES) have gained great popularity because of extraordinarily low rates of restenosis. Despite these superior clinical outcomes, several cases regarding the severe multi-vessel coronary spasm, although rare, after the placement of first generation DES have been reported. We report a case of severe, multi-vessel coronary spasm that occurred two occasions after placement of a zotarolimus-eluting stent, one of the second generation DES, in a 42-year-old man with unstable angina. The first incidence was relieved by intracoronary nitroglycerin alone, and second incident, which had combined fixed stenosis was treated with intracoronary nitroglycerin and everolimus-eluting stent.

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