Does the presence of multivessel disease with or without a chronic total occlusion predict early and late mortality in STEMI patients with and without cardiogenic shock?
The presence of a concurrent chronic total occlusion in STEMI patients with multivessel disease is a strong driver of both short- and long-term mortality, particularly in those without cardiogenic shock.
AIMS: To evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS). METHODS AND RESULTS: A total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5-year follow-up with a landmark set at 30 days. In patients without CS (n = 4409), only MVD with a CTO was an independent predictor for 30-day hazard ratio (HR) 2.8, P < 0.01 and 5-year mortality (HR 1.7, P < 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients (n = 609), MVD with and without a CTO were independent predictors for 30-day mortality (HR 2.2, P < 0.01 and HR 1.8, P < 0.01). In 30-day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P = 0.06). CONCLUSION: In non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality.
Hoebers et al. (2012) studied this question.