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Impact of Chronic Total Occlusions on Outcomes of Patients With Acute Myocardial Infarction Undergoing Percutaneous

James Xu1, Amitkumar Patel2, Perwaiz Meraj2

  • 1Department of Cardiology, North Shore University Hospital, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, NY, United States of America; Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|June 23, 2022
PubMed

Insights

Chronic total occlusions (CTOs) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) are linked to worse outcomes. This includes higher in-hospital mortality, longer stays, and increased costs, highlighting a higher-risk patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Limited contemporary data exists on the impact of chronic total occlusions (CTOs) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).
  • Understanding these outcomes is crucial for optimizing treatment strategies in high-risk cardiac patients.

Purpose of the Study:

  • To evaluate the in-hospital outcomes of patients with and without CTOs presenting with AMI who underwent PCI.
  • To identify the specific risks associated with CTOs in this patient population.

Main Methods:

  • A retrospective analysis of the National Inpatient Sample (NIS) database from October 2015 to December 2017.
  • Identification of AMI patients undergoing PCI using ICD-10 codes.
  • A 1:1 propensity-score matched analysis comparing outcomes between patients with and without CTOs.

Main Results:

  • Out of 576,760 admissions, 8.8% had CTOs. After matching, each group had 51,210 admissions.
  • In-hospital mortality was significantly higher in the CTO group (4.7% vs. 3%, p < 0.0001).
  • The CTO group experienced longer hospital stays (median 3 vs. 2 days), lower discharge-to-home rates (78.8% vs. 81.1%), and higher hospitalization costs ($20,921 vs. $19,856).

Conclusions:

  • The presence of CTOs in AMI patients undergoing PCI identifies a significantly higher-risk cohort.
  • CTOs are associated with increased in-hospital mortality, prolonged hospital stays, and greater healthcare costs.
  • These findings underscore the importance of considering CTOs in risk stratification and management of AMI patients undergoing PCI.
Abstract

Keywords:
Acute myocardial infarctionChronic total occlusionPropensity score matching

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