Acute Total Occlusion elevates Long-Term Risk of MACE in NSTEMI Patients undergoing PCI: Study
RPGMC-Tanda’s Road to PGIMER
A new study published in The American Journal of Cardiology revealed acute total occlusion (ATO) in non-ST-segment elevation myocardial infarction (NSTEMI) patients undergoing PCI, which was most common in the left circumflex artery. ATO was associated with a 46% higher risk of major adverse cardiovascular events (MACE) over 3.6 years (aHR 1.46; p=0.002).
In a retrospective analysis of 1,128 NSTEMI patients who underwent coronary angiography this research was set determine the impact of vessel occlusion on clinical outcomes. The patients were divided into a group with total occlusion (TO) and other group with non-total occlusion (Non-TO). The study followed patients for a median of 3.6 years to track the occurrence of MACE, including all-cause death, non-fatal heart attack, non-fatal stroke, unplanned revascularization, and hospitalization for heart failure.
The analysis found that 286 patients (25.4%) had acute total occlusion, with the left circumflex artery being the most commonly affected vessel. These patients tended to have more severe clinical presentations and a higher burden of cardiovascular risk factors compared to those in the Non-TO group.
When outcomes were compared, thepatients in the TO group showed a 46% higher risk of MACE than those without complete blockage. The adjusted hazard ratio (aHR) was 1.46, with a 95% confidence interval (CI) of 1.16–1.83 and a p-value of 0.002, indicating a statistically significant difference. Total vessel blockage at the time of diagnosis was a strong predictor of poorer long-term outcomes.
While incorporating occlusion status into the well-known GRACE risk score, the predictive accuracy for MACE improved. This suggests that knowing whether the culprit artery is completely blocked could help clinicians more accurately identify high-risk patients and tailor treatment strategies accordingly.
A detailed breakdown of patient characteristics showed that those in the TO group had higher rates of cardiac enzyme elevation, lower left ventricular ejection fractions (indicating reduced heart pumping function), and more frequent multi-vessel disease. The rate of subsequent hospitalizations and revascularization procedures was also notably higher among these patients.
Overall, these findings highlighted that acute total occlusion in NSTEMI patients independently predicts worse cardiovascular outcomes, and integrating this parameter into existing risk models could enhance clinical decision-making and improve patient management in real-world settings.
Source:
Yu, Q., Wang, S., Zhao, Y., Zhao, Y., Zeng, J., Wang, Y., Fan, Z., Liu, F., & Liu, Z. (2025). Impact of acute total occlusion of the culprit vessel on prognosis and risk stratification in patients with non-ST-segment elevation myocardial infarction. The American Journal of Cardiology, 254, 139–146. https://doi.org/10.1016/j.amjcard.2025.07.042
