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Published on: May 28, 2019
Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment
Kong-Yong Cui1, Fei Yuan1, Hong Liu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Insights
Staged recanalization of chronic total occlusion (CTO) in non-culprit vessels significantly improves long-term outcomes for ST-segment elevation myocardial infarction (STEMI) patients post-primary PCI. This intervention reduces major adverse cardiovascular events compared to medical therapy alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) often have concomitant chronic total occlusions (CTOs) in non-culprit vessels.
- The prognostic impact of staged CTO recanalization in this patient group remains debated.
Purpose of the Study:
- To compare the long-term clinical outcomes of staged CTO recanalization versus medical therapy in STEMI patients with non-culprit CTOs after primary PCI.
Main Methods:
- A retrospective study of 287 STEMI patients with non-culprit CTOs between 2005-2016.
- Patients were divided into staged CTO-PCI (n=91) and medical therapy (n=196) groups.
- Propensity-score matching created 77 well-balanced pairs for analysis of major adverse cardiovascular and cerebrovascular events (MACCE).
Main Results:
- Over a mean follow-up of 6.06 years, staged CTO-PCI significantly reduced MACCE in both overall (22.0% vs. 46.9%) and matched cohorts (22.1% vs. 42.9%).
- Staged CTO-PCI also lowered risks of cardiac death, nonfatal MI, or stroke, and all-cause mortality.
- Independent association of staged CTO-PCI with reduced MACCE and mortality was confirmed after adjusting for confounders.
Conclusions:
- Successful staged recanalization of CTOs in non-culprit vessels improves long-term clinical outcomes for STEMI patients post-primary PCI.
- This strategy offers a significant benefit over medical therapy alone in managing complex coronary artery disease.
Background:
In patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), approximately 10% are concomitant with a chronic total occlusion (CTO) in a non-culprit vessel. However, the impact of staged CTO recanalization on prognosis in this cohort remains disputable. This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.
Methods:
Between January 2005 and December 2016, a total of 287 patients were treated with staged CTO-PCI (n = 91) or medical therapy (n = 196) after primary PCI in our center. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, nonfatal myocardial infarction (MI), stroke or unplanned revascularization. After propensity-score matching, 77 pairs of well-balanced patients were identified.
Results:
The mean follow-up period was 6.06 years. Overall, the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population (22.0% vs. 46.9%; hazard ratio (HR) = 0.48, 95% CI: 0.29-0.77) and propensity-matched cohorts (22.1% vs. 42.9%; HR: 0.48, 95% CI: 0.27-0.86). In addition, staged CTO-PCI was also associated with reduced risk of the composite of cardiac death, nonfatal MI or stroke compared with medical therapy in both overall population (9.9% vs. 26.5%; hazard ratio (HR) = 0.39, 95% CI: 0.19-0.79) and propensity-matched cohorts (9.1% vs. 22.1%; HR: 0.40, 95% CI: 0.16-0.96). After correction of the possible confounders, staged CTO-PCI was independently associated with reduced risks of MACCE (adjusted HR: 0.46, 95% CI: 0.28-0.75), the composite of cardiac death, nonfatal MI or stroke (adjusted HR: 0.45, 95% CI: 0.22-0.94) and all-cause mortality (adjusted HR: 0.32, 95% CI: 0.13-0.83). Moreover, the results of sensitivity analysis were almost concordant with the overall analysis.
Conclusions:
In patients with STEMI and a concurrent CTO who undergo primary PCI, successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.
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