Key result
Non-infarct-related artery CTO was associated with higher 24-month mortality in men with NSTEMI and multivessel CAD (24.3% vs 13.4%, p=0.009; adjusted HR 1.62, p=0.087), but not in women (18.9% vs 14.7%, p=0.47).
Why the study?
Does the presence of a chronic total occlusion in a non-infarct-related artery increase 24-month all-cause mortality differently in men versus women presenting with NSTEMI and multivessel coronary artery disease?
Cohort (n=515)
No
Does the presence of a chronic total occlusion in a non-infarct-related artery increase 24-month all-cause mortality differently in men versus women presenting with NSTEMI and multivessel coronary artery disease?
In patients with NSTEMI and multivessel CAD, non-infarct-related artery CTO is equally prevalent in both sexes (~44%) and significantly increases 24-month mortality in men, whereas no statistically significant mortality difference was observed in women.
// Mateusz Tajstra 1 , Michał Hawranek 1 , Piotr Desperak 1 , Aneta Ciślak 1 and Mariusz Gąsior 1 1 Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland Correspondence to: Mateusz Tajstra, email: // Keywords : gender, sex, chronic total occlusion, non-ST-segment elevation myocardial infarction, percutaneous coronary intervention Received : November 22, 2016 Accepted : March 03, 2017 Published : March 11, 2017 Abstract A chronic total occlusion in a non-infarct-related artery is an independent predictor of mortality in non-ST elevation myocardial infarction. There are no mortality data about the impact of a chronic total occlusion in patients with non-ST elevation myocardial infarction according to gender. The purpose of this study was to evaluate the prevalence of the chronic total occlusion in in men and women and examine its impact on clinical outcomes. Data from consecutive patients with multivessel coronary artery disease treated in a high-volume center between 2006 and 2012 were included in a prospective registry and divided according to gender and the presence of chronic total occlusion. All of the analyzed patients were followed up for at least 24 months, with all-cause mortality defined as the primary endpoint. Among the 515 patients who fulfilled the inclusion criteria, 32.8% were female. In the female arm, the 24-month mortality for the groups with and without chronic total occlusion was similar (18.9% and 14.7%, respectively; p = 0.47). In contrast, in the male arm, the occurrence of chronic total occlusion was associated with higher 24-month mortality (24.3% vs. 13.4%; p = 0.009). Multivariate analysis of the male arm revealed a trend toward a positive association between the occurrence of chronic total occlusion and 24-month mortality (HR 1.62; 95% CI 0.93–2.83; p = 0.087). The presence of chronic total occlusion in men is associated with an adverse long-term prognosis, whereas in women this effect was not observed.
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Tajstra et al. (2017) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel coronary artery disease (MVCAD) (n=515). Chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA), stratified by gender vs. Absence of chronic total occlusion in a non-infarct-related artery (CTO-), stratified by gender was evaluated on 24-month all-cause mortality (in male cohort) (HR 1.94, 95% CI 1.17-3.20, p=0.0098). Non-infarct-related artery CTO was associated with higher 24-month mortality in men with NSTEMI and multivessel CAD (24.3% vs 13.4%, p=0.009; adjusted HR 1.62, p=0.087), but not in women (18.9% vs 14.7%, p=0.47).
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