Impact of chronic total occlusion on prognosis in cardiogenic shock due to unprotected left main coronary artery...

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Myocardial Infarction Research

Background:

• Cardiogenic shock (CS) from unprotected left main culprit lesion-related acute myocardial infarction (ULMCL-related AMI) carries a high mortality rate despite medical advancements.
• Chronic total occlusions (CTOs) are frequently observed in patients with ULMCL-related AMI and CS.

Purpose of the Study:

• To investigate the association between the presence of CTO and 12-month mortality in patients with CS due to ULMCL-related AMI.

Main Methods:

• A prospective registry study (Polish Registry of Acute Coronary Syndromes - PL-ACS) included 250 patients with AMI-related CS and ULMCL treated with percutaneous coronary intervention (PCI).
• Patients were stratified into groups with (+CTO) and without (-CTO) at least one major coronary artery CTO.
• The primary endpoint was all-cause death at 12 months.

Main Results:

• 24% of patients had at least one CTO (+CTO group).
• 12-month mortality was significantly higher in the +CTO group (85%) compared to the -CTO group (69.8%; P log-rank = 0.03).
• After multivariable adjustment, CTO presence remained a significant predictor of increased 12-month mortality (HR, 1.423; P = 0.034).

Conclusions:

• In patients with CS due to ULMCL-related AMI undergoing PCI, the presence of CTO is associated with a worse 12-month prognosis.
• CTO is an independent predictor of mortality in this high-risk patient cohort.