Predictors of Total Occlusion of the Culprit Artery in Low-to-Intermediate Risk NSTEMI-ACS: A Retrospective Study

Introduction: In patients with low-to-intermediate risk acute non-ST-elevation myocardial infarction–acute coronary syndrome (NSTEMI-ACS), non-invasive treatments have gained importance. However, these patients may present with a wide spectrum, ranging from microvascular involvement to partial or complete epicardial artery occlusion. Patients with total occlusion of the culprit artery have higher morbidity and mortality rates. Early invasive treatment may reduce these rates. Therefore, early identification of such patients is important. Nonetheless, no specific clinical or laboratory distinguishing factors have been identified. This study aimed to investigate the role of inflammatory markers in identifying patients with total occlusion of the culprit artery among those with low-to-intermediate risk NSTEMI-ACS. Patients and Methods: This retrospective cohort study included patients diagnosed with NSTEMI-ACS who underwent coronary angiography in a tertiary cardiology clinic between January 2018 and December 2019. A total of 276 patients were enrolled, while 32 meeting exclusion criteria were excluded. The remaining patients were classified as those with total occlusion of the culprit artery (n=47) and those without (n=229). Inflammatory markers were compared between groups. Results: Statistically significant differences were found between the groups in terms of neutrophil-to-lymphocyte ratio (NLR) (p=0.01), systemic immune-inflammation index (SII) (p=0.016), and mean platelet volume (MPV) (p=0.028). Conclusion: According to the findings of this study, NLR, SII, and MPV may be useful in determining the presence of total occlusion of the culprit artery in NSTEMI-ACS patients. However, the causal relationship between these parameters and total occlusion remains unclear. Larger, multicenter studies are required to confirm their predictive value and determine the ideal cutoff points.