Key result
Complete revascularization with successful CTO recanalization is linked to ~65% lower MACCE risk.
Why the study?
The clinical relevance of chronic total occlusion revascularization in patients with non-ST-segment elevation myocardial infarction and multivessel disease remained uncertain.
Does complete revascularization involving successful chronic total occlusion recanalization reduce major adverse cardiovascular and cerebrovascular events in patients with NSTEMI, multivessel disease, and chronic total occlusion?
Cohort (n=632)
Yes
Does complete revascularization involving successful chronic total occlusion recanalization reduce major adverse cardiovascular and cerebrovascular events in patients with NSTEMI, multivessel disease, and chronic total occlusion?
In patients with NSTEMI and multivessel disease with a chronic total occlusion (CTO), achieving complete revascularization including successful CTO recanalization is associated with significantly lower mid-term rates of MACCE and MACE, whereas revascularizing only non-CTO lesions without opening the CTO offers no prognostic benefit.
Answers are grounded in this paper and cite their sources.
May support CTO-inclusive complete revascularization in NSTEMI with multivessel disease; hypothesis-generating and requires randomized confirmation.
Background The clinical relevance of chronic total occlusion (CTO) revascularization in patients with non–ST‐segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain. Methods In this multicenter retrospective cohort study, 632 patients with NSTEMI, MVD, and CTO were included. Patients were categorized into a complete revascularization group involving successful CTO recanalization (CR‐CTO, n = 119) and an incomplete revascularization group without successful CTO recanalization (ICR‐CTO, n = 513). The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE). Results During a mean follow‐up of 528 ± 201 days, the incidences of MACCE (11.8% vs. 28.5%) and MACE (7.6% vs. 24.2%) were significantly lower in the CR‐CTO group than in the ICR‐CTO group (both p < 0.001). In multivariable Cox regression analyses, CR‐CTO was independently associated with lower risks of MACCE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.20–0.61) and MACE (HR, 0.26; 95% CI, 0.13–0.51). Among patients without successful CTO recanalization, additional revascularization of non‐CTO lesions was not associated with improved outcomes. Conclusions In patients with NSTEMI, MVD, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid‐term clinical outcomes. In contrast, additional revascularization of non‐CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized. These findings suggest that CTO revascularization status may warrant specific consideration when revascularization strategies are evaluated in this patient population.
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Liu et al. (2026) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) and chronic total occlusion (CTO) (n=632). Complete revascularization involving successful CTO recanalization (CR-CTO) vs. Incomplete revascularization without successful CTO recanalization (ICR-CTO) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE) (HR 0.35, 95% CI 0.20-0.61, p=<0.001). Complete revascularization with successful CTO recanalization was associated with lower risks of MACCE (HR 0.35; 95% CI 0.20-0.61) and MACE (HR 0.26; 95% CI 0.13-0.51; both P<0.001).
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