Letter to the Editor: Culprit coronary occlusion as a stronger short-term prognostic marker over electrocardiographic pattern in acute myocardial infarction

Abstract

Kos et al recently published a study in World Journal of Cardiology report that an acute myocardial infarction patient’s outcome is more strongly determined by whether the culprit artery is totally occluded than by the initial electrocardiographic presentation. In this Letter, we highlight the clinical significance of their finding that ST-segment elevation on electrocardiogram was not an independent predictor of 30-day mortality, underscoring the importance of angiographic occlusion status. We discuss the utility and caveats of using troponin levels as a surrogate for infarct size, the observed protective association of chronic statin therapy with lower likelihood of occlusion, and the need for earlier detection of occlusions. We share the authors’ view that integrating culprit vessel patency into acute myocardial infarction risk assessment is essential and that an “occlusion myocardial infarction” approach may improve triage decisions and outcomes.

Keywords: Infarct-related artery occlusion; Electrocardiographic presentation; Acute myocardial infarction; Troponin; Statin therapy

Core Tip: This letter discusses the study by Kos et al and emphasizes that in acute myocardial infarction, the presence of a totally occluded culprit artery drives short-term mortality risk more than the electrocardiogram classification (ST-segment elevation vs non-ST segment elevation). We also note troponin as a practical, but imperfect, surrogate for infarct size and urge cautious interpretation. Finally, the association between previous statin use and a lower likelihood of presentation with total occlusion suggests plaque stabilizing effects of statins that merit further investigation.