| Summary: | Background About one-fourth of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are found with total occlusion of the culprit artery, and their outcomes are poor. However, there is little research in this population in China. Objective To identify the possible influencing factors of total occlusion of the culprit artery and long-term outcomes following percutaneous coronary interventions (PCI) in patients with NSTE-ACS. Methods Three hundred and seven NSTE-ACS patients with PCI treatment were recruited from the Third People's Hospital of Chengdu from January 2018 to December 2019, among whom, 42 with total occlusion of the culprit artery (pre-PCI TIMI grade 0 or 1, occlusion group) , and other 265 without (pre-PCI TIMI grade 2 or 3, non-occlusion group) . The baseline characteristics and results of regular follow-ups were collected. The endpoints were major adverse cardiac and cerebrovascular events (MACCE) , including all-cause death, recurrent myocardial infarction, revascularization, and new stroke. Multivariate Logistic regression was used to identify the potential influencing factors of total occlusion of the culprit artery. The Kaplan-Meier was used to estimate the cumulative incidence of MACCE. Multivariate Cox regression was adopted to assess the influence of total occlusion of the culprit artery on prognosis. Results Compared with non-occlusion group, occlusion group had higher prevalence of non-ST-segment elevation acute myocardial infarction and the left circumflex coronary artery as the culprit vessel, as well as higher levels of hypersensitive troponin T, creatine kinase isoenzyme and B-type natriuretic peptide at admission (P<0.05) . Moreover, occlusion group had lower level of systolic blood pressure and left ventricular ejection fraction (LVEF) , as well as the left anterior descending coronary artery as the culprit vessel at admission (P<0.05) . The results of multivariate Logistic regression analysis showed LVEF〔OR=1.064, 95%CI (1.018, 1.112) , P=0.006〕 was associated with total occlusion of the culprit artery in NSTE-ACS. Occlusion group had higher cumulative incidence of MACCE, revascularization or new stroke than non-occlusion group (P<0.05) . After adjusting for confounding factors, multivariate Cox regression analysis revealed that total occlusion of the culprit artery was associated with MACCE〔OR=2.684, 95%CI (1.229, 5.862) , P=0.013〕 and revascularization〔OR=3.024, 95%CI (1.320, 6.931) , P=0.009〕 in NSTE-ACS. Conclusion LVEF may be an associated factor of total occlusion of the culprit artery in patients with NSTE-ACS. Therefore bedside echocardiography is recommended as a routine examination before coronary angiography in patients with NSTE-ACS. In addition, total occlusion of the culprit artery is an influencing factor of MACCE, revascularization, and new stroke in these patients.
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