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Determinants of Coronary Angiography in Non-ST-elevation Myocardial Infarction with Low Ejection Fraction



Objective:

To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI).


Study design:

Descriptive study.


Place and duration of study:

This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021.


Methodology:

Patients with SLVSD (Ejection fraction <30%) developing Clinical and demographic factors were compared between the patients who were or were not decided for angiography. Associated factors for the decision of angiography were evaluated.


Results:

Overall, 68 (46%) out of 147 patients underwent coronary angiography. Angiography led to coronary artery bypass grafting (CABG) in 14 (21%), percutaneous coronary intervention (PCI) in 30 (44%), and medical treatment in 24 (35%). Among the patients who decided for CABG, 10 (71%) underwent surgery. In multivariate analysis; Killip score ≥2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p<0.001], lower education level (OR: 17.66, 95% CI: 2.25-138.44, p=0.006), anaemia (OR: 10.60, 95% CI: 2.07-54.28, p=0.005), age ≥65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography.


Conclusion:

Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI.


Key words:

Heart failure, NSTEMI, Revascularisation, Severe left ventricular systolic dysfunction, Ejection fraction.



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