Kos N, Zeljković I, Golubic K, Radeljic V, Erceg M, Cigrovski Berkovic M, Delic-Brkljacic D, Bulj N. Reply: Culprit coronary occlusion as a stronger short-term prognostic marker over electrocardiographic pattern in acute myocardial infarction. World J Cardiol 2026; 18(7): 123995 [DOI: 10.4330/wjc.123995]
Corresponding Author of This Article
Nikola Kos, MD, PhD, Department of Cardiology, University Hospital Centre Sestre Milosrdnice, Vinogradska 29, Zagreb 10000, Croatia. nikolakos89@gmail.com
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Cardiac & Cardiovascular Systems
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letter
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Kos N, Zeljković I, Golubic K, Radeljic V, Erceg M, Cigrovski Berkovic M, Delic-Brkljacic D, Bulj N. Reply: Culprit coronary occlusion as a stronger short-term prognostic marker over electrocardiographic pattern in acute myocardial infarction. World J Cardiol 2026; 18(7): 123995 [DOI: 10.4330/wjc.123995]
World J Cardiol. Jul 26, 2026; 18(7): 123995 Published online Jul 26, 2026. doi: 10.4330/wjc.123995
Reply: Culprit coronary occlusion as a stronger short-term prognostic marker over electrocardiographic pattern in acute myocardial infarction
Nikola Kos, Ivan Zeljković, Karlo Golubic, Vjekoslav Radeljic, Marijan Erceg, Maja Cigrovski Berkovic, Diana Delic-Brkljacic, Nikola Bulj
Nikola Kos, Vjekoslav Radeljic, Diana Delic-Brkljacic, Nikola Bulj, Department of Cardiology, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
Ivan Zeljković, Department of Cardiology, University Hospital Dubrava, Zagreb 10000, Croatia
Karlo Golubic, Department of Cardiovascular Diseases, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
Marijan Erceg, Department of Helath, Croatian Institute of Public Health, Zagreb 10000, Croatia
Maja Cigrovski Berkovic, Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Kos N designed the original study; Kos N, Zeljković I, Golubic K, Radeljic V, Erceg M, Cigrovski Berkovic M, Delic-Brkljacic D and Bulj N performed the research, analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
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Corresponding author: Nikola Kos, MD, PhD, Department of Cardiology, University Hospital Centre Sestre Milosrdnice, Vinogradska 29, Zagreb 10000, Croatia. nikolakos89@gmail.com
Received: June 4, 2026 Revised: June 23, 2026 Accepted: July 6, 2026 Published online: July 26, 2026 Processing time: 44 Days and 12.7 Hours
Abstract
Singh and Lima's commentary published in World Journal of Cardiology underscores the clinical importance of integrating angiographic occlusion status into acute myocardial infarction (AMI) risk stratification. In our response, we affirm that total culprit-artery occlusion provides independent prognostic information not captured by electrocardiographic classification alone and remains a strong independent predictor of 30-day mortality even after adjustment for peak troponin levels. We address the limitations of troponin as a surrogate for infarct size and discuss potential mechanisms—including microvascular obstruction, no-reflow, and arrhythmic risk—that may explain the persistent prognostic significance of occlusion beyond infarct size. We also contextualize the association between chronic statin therapy and lower likelihood of presenting with total occlusion. Our response reinforces the emerging OMI/NOMI paradigm as a more appropriate approach for AMI risk assessment than ST-elevation per se.
Core Tip: This response emphasizes that angiographic occlusion status is a strong independent prognostic marker in acute myocardial infarction (AMI), providing information beyond electrocardiographic classification and peak troponin levels. The persistent independent association with mortality suggests mechanisms beyond infarct size alone—including microvascular dysfunction and no-reflow—warranting investigation as hypotheses in future prospective studies. The association between chronic statin therapy and lower likelihood of total occlusion may reflect plaque-stabilizing effects, though requiring prospective validation. These findings support the emerging OMI/NOMI paradigm as superior to traditional electrocardiography-based AMI classification for risk stratification.
