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(384) Comparison of Right and Left Coronary Artery Occlusion Myocardial Infarctions


Authors:

Daniel D. Singer, MD – Resident, SUNY at Stony Brook

Alexander Bracey, MD – Attending Physician, Stony Brook University

H Pendell Meyers, MD – Fellow, Stony Brook University

Wei Li, MD – Resident, SUNY, Stony Brook

Henry Thode, Jr., PhD – Assistant Professor, Stony Brook University

Adam Singer, MD – Professor and Vice Chairman for Research, Stony Brook University

Catherine Silberstein

Abstract:

Background and Objectives: It is common belief that myocardial infarctions (MI) due to occlusion of the right coronary artery or its tributaries are more likely to present atypically than myocardial infarctions resulting from occlusion of the left coronary artery or its tributaries. We compared clinical presentations and peak cardiac troponins (cTn) in patient with right dominant or left dominant acute coronary occlusion myocardial infarctions. We hypothesized that the percentage of typical symptoms and cTn would be higher with left sided occlusions.

Methods: We performed a case-control study by combining patients from 1) a consecutive cohort of ED patients with suspected ACS over a 4-month period who underwent cardiac catheterization, and 2) an additional group of occlusion myocardial infarction cases from our catheterization lab activation database. Patients were included in the study if they had an acute occlusion of a culprit coronary artery and myocardial infarction based on WHO criteria. Data collected included baseline demographic and clinical information, presenting symptoms, initial and peak cTn, results of the coronary catheterization and any subsequent echocardiograms. Patients were then grouped into those with right coronary artery or its tributaries occlusion or left coronary artery or its tributary occlusions. Groups were compared with chi-square and t-tests.

Results: There were 125 patients included in the study of which 4 were excluded since they had both right and left sided occlusions. Mean (SD) age was 65 (13) years, 76% were male, and 89% were white. There were 41 (34%) patients with right sided occlusions and 80 (66%) with left sided occlusions. Mean age, percent male, and percent white were similar in both groups. The proportion of patients presenting with chest pain and shortness of breath was similar in patients with right and left sided occlusions (93% vs 84%, p=0.28 and 54% vs 46%, p=0.50; respectively). Prior history of MI, PCI, and CABG did not differ between the groups. Patients with left sided occlusions had higher initial (0.9 vs 0.4, p=0.01) and peak (7.1 vs 3.6, p<0.01) cTn levels, respectively.

Conclusion: Patient baseline and clinical characteristics are similar between patients presenting with right and left acute coronary occlusion MIs. Patients with left coronary occlusion MIs have larger infarct sizes based on initial and peak cTn levels.

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