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.
Insights
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.
Objectives:
To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort.
Background:
There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO.
Methods:
Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes.
Results:
There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %.
Conclusions:
In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.
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