[The acute and long-term outcome of patients with ST segment elevation myocardial infarction concurrent with chronic
1Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, China Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) have higher in-hospital and 1-year mortality after primary percutaneous coronary intervention (PCI). Chronic total occlusion, advanced age, and heart failure history are independent risk factors for mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring immediate intervention.
- Chronic total occlusion (CTO) presents a significant challenge in STEMI management.
- The impact of concurrent CTO on STEMI outcomes following primary percutaneous coronary intervention (PCI) requires thorough evaluation.
Purpose of the Study:
- To assess the acute and long-term clinical outcomes of STEMI patients with concurrent CTO undergoing primary PCI.
- To identify risk factors associated with mortality in this patient population.
Main Methods:
- A cohort of 11,905 STEMI patients from the China Acute Myocardial Infarction Registry was analyzed.
- Patients were categorized into CTO and non-CTO groups based on angiography during primary PCI.
- Propensity score matching (1:3 ratio) was employed to create comparable groups for analysis, focusing on in-hospital and 1-year mortality and major adverse cardiovascular events (MACE).
Main Results:
- The study identified 931 (7.8%) STEMI patients with CTO.
- After propensity score matching, in-hospital mortality was significantly higher in the CTO group (4.2%) compared to the non-CTO group (2.4%).
- One-year outcomes revealed significantly higher rates of all-cause death, cardiac death, and MACE in the CTO group compared to the non-CTO group.
Conclusions:
- STEMI patients with concurrent CTO experience significantly increased in-hospital and 1-year mortality.
- Chronic total occlusion, advanced age, and a history of heart failure are identified as independent risk factors for 1-year mortality in STEMI patients.
Abstract:
Objective: To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI). Methods: 11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI. Results: There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, P<0.001, 5.3% vs. 2.6%, P=0.001, 35.1% vs. 23.3%, P<0.001, respectively). Multiple regression analysis showed that CTO (HR=1.54, 95%CI 1.06-2.22, P=0.022), advanced age (HR=1.06, 95%CI 1.04-1.08, P<0.001), and previous heart failure history (HR=4.10, 95%CI 1.90-8.83, P<0.001) were independent risk factors of 1-year mortality. Conclusions: The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.
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