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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST-Segment-Elevation
Pedro A Villablanca1, Wilman Olmedo2, Michael Weinreich2
1Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
Insights
Percutaneous coronary intervention for chronic total occlusion (CTO) in noninfarct-related arteries of ST-segment-elevation myocardial infarction patients significantly reduces major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Chronic total occlusion (CTO) in a noninfarct-related artery is associated with increased mortality in ST-segment-elevation myocardial infarction (STEMI) patients.
- The benefit of staged revascularization for noninfarct-related artery CTO in STEMI patients remains uncertain.
Purpose of the Study:
- To compare outcomes between STEMI patients with concurrent CTO who underwent percutaneous coronary intervention (PCI) of a noninfarct-related artery CTO versus those who did not.
- To evaluate the impact of staged revascularization on major adverse cardiovascular events and mortality.
Main Methods:
- A meta-analysis of six studies involving 1253 patients with STEMI and concurrent CTO.
- Primary endpoint: major adverse cardiovascular events. Secondary endpoints: all-cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization, stroke, and heart failure readmission.
- Random effects model used to compute odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- PCI of noninfarct-related artery CTO was associated with a significant reduction in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32-0.91).
- Significant reductions observed in cardiovascular mortality (OR, 0.43; 95% CI, 0.20-0.95) and heart failure readmissions (OR, 0.57; 95% CI, 0.36-0.89).
- No significant differences found for all-cause mortality, myocardial infarction, repeat revascularization, or stroke.
Conclusions:
- Percutaneous coronary intervention for noninfarct-related artery CTO in STEMI patients significantly reduces major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
- Staged revascularization of noninfarct-related CTO in STEMI patients improves key clinical outcomes.
Background:
Studies have shown that chronic total occlusion (CTO) in a noninfarct-related artery in patients with ST-segment-elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct-related artery CTO in patients with ST-segment-elevation myocardial infarction translates to improved outcomes. We performed a meta-analysis to compare outcomes between patients presenting with ST-segment-elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct-related artery CTO versus those who did not.
Method And Results:
We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all-cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32-0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20-0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36-0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all-cause mortality (OR, 0.47; 95% CI, 0.22-1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41-1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56-2.27), and stroke (OR, 0.51; 95% CI, 0.20-1.33).
Conclusions:
In this meta-analysis, CTO percutaneous coronary intervention of the noninfarct-related artery in patients presenting with ST-segment-elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
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