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Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation
Bimmer E Claessen1, George D Dangas, Giora Weisz
1Cardiovascular Research Foundation, New York, NY 10022, USA.
European Heart Journal
|January 14, 2012
Summary
Multivessel disease (MVD) in patients with ST-segment elevation myocardial infarction (STEMI) increases early mortality. The presence of a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) also predicts increased late mortality after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- Multivessel disease (MVD) is common in STEMI patients and may impact outcomes.
- The role of chronic total occlusions (CTOs) in non-infarct-related arteries (non-IRAs) in STEMI is not fully understood.
Purpose of the Study:
- To investigate the impact of MVD with and without CTO in a non-IRA on mortality in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Analysis of data from the HORIZONS-AMI trial, including 3283 patients undergoing primary PCI.
- Comparison of outcomes between single-vessel disease (SVD), MVD without CTO, and MVD with CTO in a non-IRA.
- Multivariable analysis to identify independent predictors of mortality.
Main Results:
- Patients with MVD and non-IRA CTO had worse procedural outcomes, including lower TIMI 3 flow, absent myocardial blush, and reduced ST-segment resolution compared to SVD and MVD without CTO.
- MVD with non-IRA CTO was an independent predictor of both early (0-30 day) and late (30 day-3 year) mortality.
- MVD without CTO was a predictor of early mortality but not late mortality.
Conclusions:
- In STEMI patients undergoing primary PCI, MVD with or without CTO in a non-IRA independently predicts early mortality.
- The presence of a CTO in a non-IRA is also an independent predictor of increased mortality up to 3 years post-procedure.
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