Mid-Term Clinical Outcomes According to CTO Revascularization Status in Patients With NSTEMI and Multivessel Disease

The clinical relevance of chronic total occlusion (CTO) revascularization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains uncertain.

In this multicenter retrospective cohort study, 632 patients with NSTEMI, MVD, and CTO were included. Patients were categorized into a complete revascularization group involving successful CTO recanalization (CR-CTO, n = 119) and an incomplete revascularization group without successful CTO recanalization (ICR-CTO, n = 513). The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE).

During a mean follow-up of 528 ± 201 days, the incidences of MACCE (11.8% vs. 28.5%) and MACE (7.6% vs. 24.2%) were significantly lower in the CR-CTO group than in the ICR-CTO group (both p < 0.001). In multivariable Cox regression analyses, CR-CTO was independently associated with lower risks of MACCE (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.20-0.61) and MACE (HR, 0.26; 95% CI, 0.13-0.51). Among patients without successful CTO recanalization, additional revascularization of non-CTO lesions was not associated with improved outcomes.

In patients with NSTEMI, MVD, and CTO, complete revascularization involving successful CTO recanalization was associated with improved mid-term clinical outcomes. In contrast, additional revascularization of non-CTO lesions alone was not associated with a prognostic benefit when CTO lesions remained unrevascularized. These findings suggest that CTO revascularization status may warrant specific consideration when revascularization strategies are evaluated in this patient population.