Impact of a chronic total occlusion in a non-infarct related artery on clinical outcomes following primary percutaneous intervention in acute ST-elevation myocardial infarction

• Published in: The Journal of invasive cardiology Vol. 26; no. 1; pp. 13 - 16
• Main Authors: Mozid, Abdul M, Mohdnazri, Shah, Mannakkara, Nilanka N, Robinson, Nicholas M, Jagathesan, Rohan, Sayer, Jeremy W, Aggarwal, Rajesh K, Clesham, Gerald J, Gamma, Reto A, Tang, Kare H, Kelly, Paul A, Davies, John R
• Format: Journal Article
• Language: English
• Published: United States 01.01.2014
• Subjects: Aged; Chronic Disease; Cohort Studies; Comorbidity; Coronary Occlusion - complications; Coronary Occlusion - epidemiology; Electrocardiography; Female; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Prognosis; Retrospective Studies; Time Factors; Treatment Outcome; United Kingdom
• ISSN: 1557-2501

We aimed to assess the impact of a non-infarct related artery (IRA) chronic total occlusion (CTO) on clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in a real-world cohort of patients. This is a retrospective observational study of 1435 patients treated at a large single tertiary cardiac center providing a high-volume PPCI service. Patients with coexisting CTO (4.7%) were significantly more likely to have presented in cardiogenic shock and less likely to achieve TIMI 2/3 flow in the IRA post procedure resulting in lower ejection fraction and higher peak troponin-T levels. A concurrent CTO in a non-IRA was associated with higher in-hospital mortality (16.4% vs 3.1%; P<.001), 30-day mortality (19.4% vs 5.9%; P<.001) and long-term mortality (23.9% vs 12.2%; P=.01). Binary logistic regression analysis showed that the presence of a non-IRA CTO was independently predictive of mortality at 30 days (odds ratio, 3.2; 95% confidence interval, 1.2-8.1) but not for long-term mortality. The presence of a coexisting CTO in patients undergoing PPCI for STEMI is associated with adverse clinical outcomes; further work is required to improve prognosis in these patients, which may include early staged revascularization of the non-IRA CTO.