Trends and In-Hospital Outcomes of Patients Admitted with ST Elevation Myocardial Infarction and Chronic Total
Shivaraj Nagalli1, Nidhi Shankar Kikkeri2, Usama Nasir3
1Department of Internal Medicine, Brookwood Baptist Health, Alabaster, AL.
Insights
Chronic total occlusion (CTO) in ST-elevation myocardial infarction (STEMI) patients is increasing. While STEMI-CTO patients experienced more complications and interventions, in-hospital mortality remained similar compared to those without CTO.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Chronic total occlusion (CTO) presents a
- double jeopardy
- scenario in ST-elevation myocardial infarction (STEMI), potentially worsening outcomes.
- Limited national data exists on the trends and outcomes of STEMI patients with CTO (STEMI-CTO).
Purpose of the Study:
- To evaluate the national trends, clinical characteristics, and in-hospital outcomes of STEMI patients with and without CTO.
- To identify differences in management and complications between STEMI-CTO and non-STEMI-CTO cohorts.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (NIS) database from 2008 to 2011.
- Comparison of demographic and clinical data, interventions, and in-hospital outcomes between STEMI patients with and without CTO.
Main Results:
- An increasing trend of CTO in STEMI patients was observed between 2008 and 2011.
- STEMI-CTO patients were younger, more prone to cardiogenic shock, and more likely to receive percutaneous coronary intervention (PCI) and thrombolysis.
- STEMI-CTO patients had higher rates of iatrogenic cardiac/vascular complications and required more percutaneous mechanical circulatory support, but in-hospital mortality was not significantly different.
Conclusions:
- CTO in STEMI patients is an increasing phenomenon with distinct clinical characteristics and management patterns.
- Despite increased procedural interventions and complications, CTO does not appear to significantly impact in-hospital mortality in STEMI patients within this dataset.
Abstract:
Chronic total occlusion (CTO) is seen in a minority of ST-elevation myocardial infarction (STEMI) patients and is implicated in poor outcomes due to "double jeopardy." There is no large national data evaluating the trend and outcomes of STEMI patients who have a CTO (STEMI-CTO). We analyzed the Nationwide In-patients sample database from 2008 to 2011 and compared the trends, clinical characteristics, and in-hospital outcomes of STEMI patients with and without CTO. An increasing trend of CTO was seen in STEMI patients from 2008 to 2011. STEMI-CTO patients were younger, more likely develop cardiogenic shock, undergo percutaneous coronary intervention and thrombolysis. In this large, contemporary, national database, we also found that STEMI-CTO patients were more likely to have iatrogenic cardiac & vascular complications and undergo percutaneous mechanical circulatory support. We did not find significant difference in in-hospital deaths between STEMI-CTO patients and those without CTO.
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