The Concurrent Chronic Total Occlusion in a Non-Infarct Artery Strongly Associate With Poor Long-Term Prognosis in Patients With Acute Myocardial Infarction and Multivessel Coronary Disease

Recently, growing evidence demonstrates that recanalization of chronic total occlusion (CTO) lesions exerts a beneficial effect in terms of improvement in left ventricular function and long-term survival by alleviating residual/recurrent angina, and reduces the need for coronary artery bypass grafting. 1)2)However, it remains unclear whether successful recanalization of a CTO in the non-infarctrelated artery (non-IRA) could improve clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI).][5] A concurrent CTO in a non-IRA is present in 12% to 13% of patients with STEMI. 3)5)In terms of primary PCI for STEMI, previous studies demonstrated that the effect of MVD on mortality is mainly determined by the presence of a CTO in a non-IRA. 4)6)The presence of CTO lesions is a risk factor for incomplete PCI revascularization, which may, in turn, increase mortality compared to complete revascularization.Tajstra et al. 7) described in a cohort of 1658 STEMI patients that the effect of MVD on mortality was primarily due to the presence of a CTO in a non-IRA, which was found to be a strong and independent predic-