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Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function
Bimmer E P M Claessen1, René J van der Schaaf, Niels J Verouden
1Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Insights
Chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) significantly increases long-term mortality and reduces left ventricular ejection fraction (LVEF). This finding highlights CTO as a critical prognostic factor beyond multivessel disease alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The prognostic implications of chronic total occlusion (CTO) in a non-infarct-related artery (IRA) following ST-segment elevation myocardial infarction (STEMI) remain unclear.
- Understanding these implications is crucial for optimizing patient management and risk stratification after STEMI.
Purpose of the Study:
- To investigate the impact of concurrent CTO in patients with STEMI on long-term mortality.
- To assess the effect of CTO on left ventricular ejection fraction (LVEF) evolution post-STEMI.
Main Methods:
- A cohort of 3,277 STEMI patients treated with primary percutaneous coronary intervention (PCI) between 1997 and 2005 was analyzed.
- Patients were stratified into single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with CTO in a non-IRA.
- Landmark survival analysis up to 5 years (landmark at 30 days) and LVEF assessment within 1 year were performed.
Main Results:
- CTO presence was a strong independent predictor of 30-day mortality (HR: 3.6) and long-term mortality in survivors (HR: 1.9).
- MVD without CTO showed a weaker association with early mortality (HR: 1.6) and lost prognostic value long-term (HR: 1.1).
- CTO was significantly associated with reduced LVEF (
Conclusions:
- Concurrent CTO, not multivessel disease alone, is independently associated with increased long-term mortality in STEMI patients, even after excluding early deaths.
- The presence of CTO is linked to impaired left ventricular ejection fraction and its further decline within the first year post-STEMI.
Objectives:
The aim of this study was to evaluate the effect of a concurrent chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) on long-term mortality and left ventricular ejection fraction (LVEF).
Background:
The impact of a CTO in a non-infarct-related artery (IRA) on prognosis after STEMI is unknown.
Methods:
Between 1997 and 2005, we admitted 3,277 STEMI patients treated with primary percutaneous coronary intervention. Patients were categorized as single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with a CTO in a non-IRA. We performed a "landmark survival analysis" to 5 years follow-up with a landmark set at 30 days. Additionally, we analyzed the evolution of LVEF within 1 year.
Results:
Of the patients, 2,115 (65%) had SVD, 742 patients (23%) had MVD without CTO, and 420 patients (13%) had a concurrent CTO. Presence of a CTO was a strong and independent predictor for 30-day mortality (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.6 to 4.7, p < 0.01), whereas MVD without CTO was a weak predictor (HR: 1.6, 95% CI: 1.2 to 2.2, p = 0.01). In 30-day survivors, CTO remained a strong predictor (HR: 1.9, 95% CI: 1.4 to 2.8, p < 0.01), and MVD lost its independent prognostic value (HR: 1.1, 95% CI: 0.8 to 1.5, p = 0.45). Furthermore, CTO was associated with LVEF
Conclusions:
The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF.
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