Badings EA, et al. - In previous studies, presentation without ST-elevation in patients with an acute coronary syndrome (ACS) due to occlusion of the left circumflex (LC) coronary artery was documented as the reason for a delay in diagnosis and revascularisation, larger infarct size and a worse prognosis in those subjects. In this subgroup analysis of the ELISA-3 study (Early or late intervention in high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS)), researchers determined the incidence, characteristics and prognosis of LC related NSTE-ACS. Also, they compared outcome of early vs late invasive strategy. Between patients with a LC and a non-LC related NSTE-ACS, outcome did not differ significantly. It was feasible to perform angiography within 12 hours of admission in LC related NSTE-ACS but this was not superior to angiography after more than 48 hours.

• In this subgroup analysis of the ELISA-3 study, it was demonstrated that in 383 out of 542 patients the culprit vessel could be identified, with the LC artery in 112 (29%) of them.
• The presence of single vessel disease was more often detected in patients with LC related ACS, and these patients underwent PCI more and CABG less frequently.
• Researchers noted that the primary endpoint of combined incidence of death, myocardial infarction and recurrent ischemia at 30 days follow-up occurred in 9.0% of LC vs 16.5% of non-LC related ACS (p=0.057).
• They also noted that enzymatic infarct size and incidence of bleeding were comparable.
• Findings demonstrated that among patients with LC related ACS, 62 patients were assigned to an early and 50 to a late invasive treatment with median time from admission to angiography of 5.5 h and 65.7 h respectively.
• In addition, occurrence of primary endpoint was observed in 9.7 and 8.0% respectively (p=1.00) with comparable enzymatic infarct size and bleeding.