What is the clinical evidence from this study?

Study design: Cohort. Population: ST-elevation myocardial infarction (STEMI) with a chronic total occlusion (CTO) in a non-infarct-related artery (n=480). Intervention: CTO located in the proximal LAD vs. CTO located in the RCA. Primary outcome: Three-year all-cause mortality (HR 2.2, 95% CI 1.1-4.5, p=0.02).

July 1, 2016Open Access

The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients

Key Result

In STEMI patients with a concurrent chronic total occlusion, a CTO located in the proximal LAD was associated with significantly increased three-year all-cause mortality compared with a CTO in the RCA (HR 2.2).

Study Design

Type

Cohort (n=480)

Multicenter

PICO

Population

ST-elevation myocardial infarction (STEMI) with a chronic total occlusion (CTO) in a non-infarct-related artery (n=480)

Intervention / Comparator

CTO located in the proximal LAD vs CTO located in the RCA

Primary Outcome

Three-year all-cause mortality — HR 2.2 (1.1-4.5), p=0.02

Main Result

Effect estimate: HR 2.2 (95% CI 1.1-4.5)

p-value: p=0.02

Limitations

Observational nature and modest cohort size
Unbalanced distribution of combinations of CTO and infarct-related arteries
Unknown or unmeasured confounders may have introduced bias
Lack of complete data on possible mechanisms explaining the observed difference in mortality, such as infarct size and left ventricular function
Coronary angiograms were not analyzed by an independent core lab

Abstract

AIMS: Several studies have evaluated the impact of a CTO on short- and long-term mortality in STEMI patients. It has been speculated that the adverse effect on prognosis could differ per coronary location. The purpose of this study was to evaluate whether the long-term prognosis of STEMI patients differs according to the coronary location of the CTO. METHODS AND RESULTS: Between 2000 and 2012, a total of 480 STEMI patients with a CTO in a non-infarct-related artery were included. The primary outcome for the present analysis was three-year all-cause mortality, evaluating the impact of the coronary CTO and infarct location. Four hundred and thirteen patients had a single CTO in a non-infarct-related artery, whereas 67 patients had more than one CTO and in this group mortality was higher. In patients with a single CTO, the highest risk of mortality was observed when the culprit lesion was located in the LAD or proximal LCX or when the CTO lesion was located in the proximal LAD. CONCLUSIONS: We previously reported that STEMI patients with a CTO have a worse prognosis than STEMI patients without a CTO. We now show that, in these patients, LAD or proximal LCX location for the culprit lesion, or proximal LAD location for the CTO lesion, is associated with the highest risk. As a result, almost all CTO patients are at increased risk for mortality due to the combination of the culprit and CTO artery location.

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Cite This Study

Hoebers et al. (Fri,) conducted a cohort in ST-elevation myocardial infarction (STEMI) with a chronic total occlusion (CTO) in a non-infarct-related artery (n=480). CTO located in the proximal LAD vs. CTO located in the RCA was evaluated on Three-year all-cause mortality (HR 2.2, 95% CI 1.1-4.5, p=0.02). In STEMI patients with a concurrent chronic total occlusion, a CTO located in the proximal LAD was associated with significantly increased three-year all-cause mortality compared with a CTO in the RCA (HR 2.2).

synapsesocial.com/papers/6a1b3e5420d1ce63c9c41c32 https://doi.org/https://doi.org/10.4244/eijv12i4a75

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