Key result
The presence of a chronic total occlusion in a non-infarct-related artery independently increased the 10-year mortality risk (OR 5.09) in patients with STEMI and multivessel disease.
Why the study?
To investigate the long-term outcome and risk factors for mortality in patients with acute STEMI and a chronic total occlusion in a non-infarct-related artery.
Does the presence of a chronic total occlusion in a non-infarct-related artery worsen long-term outcomes in patients with STEMI and multivessel disease undergoing primary PCI?
Cohort (n=323)
No
Does the presence of a chronic total occlusion in a non-infarct-related artery worsen long-term outcomes in patients with STEMI and multivessel disease undergoing primary PCI?
Effect estimate: OR 5.09 (95% CI 1.79-14.54)
Absolute Event Rate: 17.5% vs 3.9%
p-value: p=<0.01
The presence of a chronic total occlusion in a non-infarct-related artery is an independent predictor of increased 10-year mortality and MACCE in patients with STEMI and multivessel disease undergoing primary PCI.
Non-IRA CTO identifies higher-risk STEMI patients; leaves open whether revascularization modifies long-term mortality.
OBJECTIVES: To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality. METHODS: The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared. RESULTS: The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47-10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO. CONCLUSIONS: The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.
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Liu et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) and multivessel diseases (MVD) (n=323). Presence of a chronic total occlusion (CTO) in a non-infarct-related artery vs. Absence of a CTO in a non-infarct-related artery was evaluated on 10-year all-cause mortality (OR 5.09, 95% CI 1.79-14.54, p=<0.01). The presence of a chronic total occlusion in a non-infarct-related artery independently increased the 10-year mortality risk (OR 5.09) in patients with STEMI and multivessel disease.
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