Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;45(2):231-238.
doi: 10.1002/clc.23755. Epub 2022 Feb 8.

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Charles Knoery  1 , Katie A McEwan  2 , Matthew Manktelow  3 , Jonathan Watt  2 , Jamie Smith  2 , Aleeha Iftikhar  3 , Khaled Rjoob  3 , Raymond Bond  3 , Victoria McGilligan  4 , Aaron Peace  5 , Anne McShane  6 , Janet Heaton  1 , Stephen J Leslie  2
Affiliations

Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction: Preangiogram prediction remains difficult

Charles Knoery et al. Clin Cardiol. 2022 Feb.

Abstract

Background: Treatment decisions in myocardial infarction (MI) are currently stratified by ST elevation (ST-elevation myocardial infarction [STEMI]) or lack of ST elevation (non-ST elevation myocardial infarction [NSTEMI]) on the electrocardiogram. This arose from the assumption that ST elevation indicated acute coronary artery occlusion (OMI). However, one-quarter of all NSTEMI cases are an OMI, and have a higher mortality. The purpose of this study was to identify features that could help identify OMI.

Methods: Prospectively collected data from patients undergoing percutaneous coronary intervention (PCI) was analyzed. Data included presentation characteristics, comorbidities, treatments, and outcomes. Latent class analysis was undertaken, to determine patterns of presentation and history associated with OMI.

Results: A total of 1412 patients underwent PCI for acute MI, and 263 were diagnosed as OMI. Compared to nonocclusive MI, OMI patients are more likely to have fewer comorbidities but no difference in cerebrovascular disease and increased acute mortality (4.2% vs. 1.1%; p < .001). Of OMI, 29.5% had delays to their treatment such as immediate reperfusion therapy. With latent class analysis, while clusters of similar patients are observed in the data set, the data available did not usefully identify patients with OMI compared to non-OMI.

Conclusion: Features between OMI and STEMI are broadly very similar. However, there was no difference in age and risk of cerebrovascular disease in the OMI/non-OMI group. There are no reliable characteristics therefore for identifying OMI versus non-OMI. Delays to treatment also suggest that OMI patients are still missing out on optimal treatment. An alternative strategy is required to improve the identification of OMI patients.

Keywords: coronary artery; myocardial infarction; occlusion/occlusive.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Latent class analysis when split into three classes based on maximum likelihood estimation
Figure 2
Figure 2
Latent class indicator probabilities differing between classes for the two NSTEMI groups
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. British Heart Foundation . Cardiovascular Disease Scotland Statistics Factsheet . 2020. Accessed September 17, 2020. https://www.bhf.org.uk/what-we-do/our-research/heart-statistics
    1. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent Trends in the incidence, treatment, and outcomes of patients with ST and non‐ST‐segment acute myocardial infarction. Am J Med. 2011;124(1):40‐47. 10.1016/j.amjmed.2010.07.023 - DOI - PMC - PubMed
    1. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group . Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343(8893):311‐322. - PubMed
    1. Collet J‐P, Thiele H, Barbato E, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2020;42:1289‐1367. 10.1093/eurheartj/ehaa575 - DOI - PubMed
    1. Khan AR, Golwala H, Tripathi A, et al. Impact of total occlusion of culprit artery in acute non‐ST elevation myocardial infarction: a systematic review and meta‐analysis. Eur Heart J. 2017;38(41):3082‐3089. 10.1093/eurheartj/ehx418 - DOI - PubMed

MeSH terms