Iranian Heart Journal

Iranian Heart Journal

Incidence of Total Occlusion of Major Coronary Arteries Without ST-T Wave Changes in Patients With Acute Coronary Syndrome

Document Type : Original Article

Authors
Mahmoud Abdelkhalekh Abouomar 1
Ahmed Faruok Alaarag 1
Ahmed Ahmed Elheet 2
Ayman Ahmed Elshikh 1
Hazem K Shalaby 1
1 Cardiology Department, Tanta Faculty of Medicine Tanta University, Egypt.
2 Department of Cardiac Science, Al Hada Armed Forces Hospitals, West Region, Taif, Saudi Arabia.
Abstract
Background: Acute coronary occlusion may occur without diagnostic ST-segment elevation. This study examined the incidence and angiographic patterns of total coronary occlusion and the impact of reperfusion timing on outcomes.

Methods: In this retrospective observational study, 300 participants with acute coronary syndrome (ACS) who presented between July 2023 and July 2024 were included. Based on admission electrocardiography (ECG), participants were categorized into 3 groups: STEMI (n = 103), ST-segment depression and/or T-wave abnormalities (n = 125), and normal ECG (n = 72). Clinical characteristics, serial cardiac biomarkers, echocardiographic findings, coronary angiographic data, door-to-balloon (DTB) time, and clinical outcomes were analyzed.

Results: Baseline characteristics were similar across groups, except for older age in participants with ST-segment depression/T-wave abnormalities (P < .001). High-sensitivity troponin elevation was common in participants with ischemic ECG changes but less frequent in those with normal ECGs (P = .001). Participants with ST-segment elevation myocardial infarction (STEMI) had more regional wall motion abnormalities and lower left ventricular ejection fraction (P = .001). Proximal left anterior descending and right coronary artery occlusions predominated in participants with ischemic ECG changes, whereas left circumflex (LCX) and obtuse marginal occlusions were more frequent in those with normal ECGs (P = .03). DTB times less than 90 minutes were achieved in 89.3%, 83.2%, and 62.5% of STEMI, ST-segment depression, and normal ECG groups, respectively (P = .001). In participants with total LCX occlusion, a DTB time less than 90 minutes was associated with lower mortality and shorter hospital stay.

Conclusions: Participants with ACS may have complete coronary occlusion despite absence of diagnostic ST-segment elevation, particularly with LCX involvement. Reliance on ECG findings alone may delay recognition and reperfusion. Serial cardiac biomarkers, echocardiography, and early invasive assessment can improve diagnostic accuracy and facilitate timely management. (Iranian Heart Journal 2026; 27(4): 60-72)
Keywords
acute coronary syndrome
acute coronary occlusion
left circumflex artery
electrocardiography
door-to-balloon time
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Iranian Heart Journal
Volume 27, Issue 4
Autumn 2026
Pages 60-72