R.E:B.E.L.EM - October 30, 2017
"Author Conclusion: “Our meta-analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes.”
Clinical Take Home Point:
Total occlusion of culprit artery in acute NSTEMI have an increased risk of MACE and all-cause mortality compared to non-total occlusion, but unfortunately there are no significant differences in high risk clinical features that can allow us to stratify these patients. If you have a patient with NSTEMI and hemodynamic instability or features of ongoing ischemia, be an advocate for your patient and push for an early invasive strategy."