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Myocardial infarction in multivessel disease: Does presence of chronic total occlusion make a difference?

Dávid Bauer1, Šimon Benjamin Špányi2, Marek Neuberg3

  • 1Department of Cardiology, University Hospital Královské Vinohrady, Prague, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.

International Journal of Cardiology
|January 14, 2025
PubMed

Insights

Myocardial infarction with multivessel disease and chronic total occlusion (CTO) did not show increased 1-year mortality compared to matched patients without CTO. Coronary artery bypass grafting (CABG) offered excellent survival regardless of CTO presence.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Myocardial infarction (MI) in patients with multivessel disease (MVD) and chronic total occlusion (CTO) is linked to high mortality.
  • The impact of CTO on all-cause mortality in a matched cohort of MVD patients without CTO remains unclear.

Purpose of the Study:

  • To analyze clinical characteristics, presenting symptoms, and survival of patients with MI and MVD.
  • To evaluate the impact of CTO on 1-year mortality in this patient population.

Main Methods:

  • A propensity score matching (PSM) analysis was conducted on 1309 MI patients with MVD.
  • Patients were compared between a CTO group (n=90) and a control group without CTO (n=90) based on age, gender, and MI type.

Main Results:

  • No significant differences were observed in presenting symptoms or initial heart rhythm between the CTO and control groups.
  • 1-year all-cause mortality was 23.3% in the CTO group and 18.9% in the control group (p=0.44).
  • Percutaneous coronary intervention (PCI) was performed in 64.4% of both groups; Coronary Artery Bypass Grafting (CABG) was performed in 18.8% and 24.4% respectively.

Conclusions:

  • No significant difference in 1-year mortality was found between MI patients with MVD and CTO compared to a matched cohort without CTO.
  • Patients treated with CABG demonstrated excellent 1-year survival, irrespective of CTO presence.
Abstract

Keywords:
Chronic total occlusionMultivessel diseaseMyocardial infarctionPercutaneous coronary intervention

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