Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study
Vinoda Sharma1, Anirban Choudhury2, Sandeep Basavarajaiah3
1Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland; University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
Summary
Patients with chronic total occlusion (CTO) in Non-ST Elevation Myocardial Infarction (NSTEMI) have worse outcomes. Revascularisation in CTO patients was associated with improved survival, despite challenges in treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Limited data exists on the clinical profile and outcomes of Non-ST Elevation Myocardial Infarction (NSTEMI) patients with chronic total occlusions (CTOs).
- Understanding these characteristics is crucial for optimizing treatment strategies and improving patient prognosis in this specific subgroup.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients diagnosed with chronic total occlusion (CTO) within a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort.
- To compare outcomes between NSTEMI patients with and without CTOs, focusing on mortality and revascularisation strategies.
Main Methods:
- A retrospective analysis was conducted using data from a six-centre percutaneous coronary intervention (PCI) registry in the UK (January 2015 - December 2020).
- NSTEMI patients were categorized into those with and without CTOs, and their baseline characteristics and clinical outcomes were compared.
Main Results:
- Out of 17,355 NSTEMI patients, 10.4% had a CTO. CTO patients were older, more likely male, and had a higher prevalence of cardiovascular risk factors.
- All-cause mortality at 30 days and 1 year was significantly higher in the CTO cohort compared to those without CTOs.
- Revascularisation in CTO patients was associated with improved survival, although success rates varied by center, and failed revascularisation led to lower survival.
Conclusions:
- The presence of a CTO in NSTEMI patients undergoing PCI is linked to adverse in-hospital and long-term outcomes.
- Timely and successful revascularisation of CTOs in NSTEMI patients may improve survival, highlighting the importance of specialized interventional techniques.
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