Can the Location of Angina Predict the Site of Coronary Artery Occlusion in Acute Myocardial Infarction? – The ACOLYTE Study

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Aim: To evaluate the relationship between the location of chest pain (topography) and the site of coronary artery involvement in patients with acute coronary syndromes (ACS) undergoing percutaneous transluminal coronary angioplasty (PTCA). Materials and methods: This prospective, observational study included 411 consecutive ACS patients admitted to a tertiary care center between January 2017 and December 2019. A total of 589 angina topographic sites were analyzed. The site and characteristics of chest pain, along with electrocardiogram and coronary angiography findings, were documented and assessed for correlation with the involved coronary artery. Results: Among the 411 patients, 337 (82.0 %) were male and 74 (18.0 %) were female. The mean age was 57.03 ± 11.28 years. In both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), the left anterior descending (LAD) artery was the most commonly affected vessel-201 cases (63.4 %) in STEMI and 49 (53.3 %) in NSTEMI. LAD occlusion correlated with retrosternal pain (r = 0.298, p = 0.001). The left circumflex artery showed a correlation with jaw and neck pain (r = 0.647, p = 0.001) and backache with shoulder pain (r = 0.585, p = 0.001). The right coronary artery correlated with retrosternal plus jaw and neck pain (r = 0.713, p = 0.001), and with retrosternal plus back pain (r = 0.719, p = 0.001). Conclusion: There is a significant correlation between the topography of chest pain and the involved coronary artery. These findings may aid in early recognition of the culprit vessel in ACS and serve as a foundation for future diagnostic tools, especially in resource-limited settings.

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