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December 2, 2016Cardiology JournalOpen Access

The presence of a chronic total occlusion independently predicted long-term mortality (OR 2.07) in STEMI patients treated with primary PCI.

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Why the study?

Does the presence of chronic total occlusion (CTO) increase long-term mortality in STEMI patients treated with primary PCI?

Population

836 STEMI patients treated with primary percutaneous coronary intervention (PCI)

Comparison

Presence of chronic total occlusion (CTO) vs Absence of CTO (non-CTO group)

Design

Cohort

Follow-up

6 years

Key result

The presence of a chronic total occlusion independently predicted long-term mortality (OR 2.07) in STEMI patients treated with primary PCI.

Authors

MLMaciej LesiakMCMonika CugowskaAAAleksander Araszkiewicz

Discussion

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Overview

CTO presence may inform risk stratification in STEMI; leaves open whether revascularization improves survival.

Study Design

Type

Cohort (n=836)

Multicenter

No

Structured PICO

Does the presence of chronic total occlusion (CTO) increase long-term mortality in STEMI patients treated with primary PCI?

P
Population
836 STEMI patients treated with primary percutaneous coronary intervention (PCI)
I
Intervention
Presence of chronic total occlusion (CTO)
C
Comparator
Absence of CTO (non-CTO group)
O
Outcome
Long-term mortality (at 6 years)hard clinical

Main Result

Effect estimate: OR 2.07 (95% CI 1.30-3.28)

Absolute Event Rate: 38.6% vs 25.4%

p-value: p=0.002

The presence of a chronic total occlusion is an independent predictor of long-term mortality in STEMI patients undergoing primary PCI.

Limitations

  • Non-randomized, observational, single centre design
  • Patients treated with older techniques (bare metal stents, no aspiration thrombectomy)
  • Lack of data on left ventricular function
  • Angiograms not reviewed by a central angiographic core lab
  • Some endpoints obtained by telephone contact
  • Lack of data on subsequent PCI procedures for CTO vessels and their success rate

Cite This Study

Lesiak et al. (2016) conducted a cohort in acute ST-segment elevation myocardial infarction (STEMI) (n=836). Presence of chronic total occlusion (CTO) vs. Absence of chronic total occlusion (non-CTO) was evaluated on 6-year all-cause mortality (OR 2.07, 95% CI 1.30-3.28, p=0.002). The presence of a chronic total occlusion independently predicted long-term mortality (OR 2.07) in STEMI patients treated with primary PCI.

synapsesocial.com/papers/6a1c80b023b9c7180b2fdcdfhttps://doi.org/10.5603/cj.a2016.0112
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