Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention: Insights from the CathPCI Registry (JACC Cardiovascular Interventions October 2026)-Article: Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention: Insights from the CathPCI Registry

Article: Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention: Insights from the CathPCI Registry

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This study examined acute coronary occlusion (ACO) among patients with NSTEMI who underwent attempted PCI in the U.S. CathPCI Registry from 2018 to 2023. Among 1,198,544 patients, 14.9% of those with NSTEMI had a complete acute occlusion; using a broader definition that included culprit-artery TIMI flow grade 0–1, the proportion was 24.4%.<br /><br />Compared with NSTEMI patients without ACO, those with ACO more often had persistent ischemic symptoms, cardiogenic shock, ventricular arrhythmias, and cardiac arrest. Their adjusted odds of in-hospital major adverse cardiovascular events (MACE)—myocardial infarction, stroke, or cardiovascular death—were more than twice as high (OR 2.26, 95% CI 2.18–2.34). However, their risk was lower than that of patients with STEMI (OR 0.54, 95% CI 0.52–0.56). This pattern also held for several other complications and with the broader ACO definition.<br /><br />The findings show that ACO is common in PCI-treated NSTEMI and is associated with worse in-hospital outcomes than NSTEMI without occlusion. The authors call for research into earlier identification and optimal reperfusion strategies. Because the registry study was observational, relied on clinician-reported diagnoses, and included only patients undergoing attempted PCI, it cannot establish whether more urgent reperfusion improves outcomes.

Meta Tag

Concept Acute Coronary Artery Occlusion

Concept NSTEMI

Concept Percutaneous Coronary Intervention

Concept In-Hospital Outcome

Concept Major Adverse Cardiac Events

Keywords

acute coronary occlusion

NSTEMI

PCI

CathPCI Registry

acute myocardial infarction

TIMI flow grade

cardiogenic shock

ventricular arrhythmias

major adverse cardiovascular events

reperfusion strategies

Acute Coronary Artery Occlusion

NSTEMI

Percutaneous Coronary Intervention

In-Hospital Outcome

Major Adverse Cardiac Events