Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention.
OBJECTIVE
The aim of this study was to evaluate the effect of a concurrent chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) on long-term mortality and left ventricular ejection fraction (LVEF).


BACKGROUND
The impact of a CTO in a non-infarct-related artery (IRA) on prognosis after STEMI is unknown.


METHODS
Between 1997 and 2005, we admitted 3,277 STEMI patients treated with primary percutaneous coronary intervention. Patients were categorized as single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with a CTO in a non-IRA. We performed a "landmark survival analysis" to 5 years follow-up with a landmark set at 30 days. Additionally, we analyzed the evolution of LVEF within 1 year.


RESULTS
Of the patients, 2,115 (65%) had SVD, 742 patients (23%) had MVD without CTO, and 420 patients (13%) had a concurrent CTO. Presence of a CTO was a strong and independent predictor for 30-day mortality (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.6 to 4.7, p < 0.01), whereas MVD without CTO was a weak predictor (HR: 1.6, 95% CI: 1.2 to 2.2, p = 0.01). In 30-day survivors, CTO remained a strong predictor (HR: 1.9, 95% CI: 1.4 to 2.8, p < 0.01), and MVD lost its independent prognostic value (HR: 1.1, 95% CI: 0.8 to 1.5, p = 0.45). Furthermore, CTO was associated with LVEF </=40% immediately after STEMI (odds ratio: 1.9, 95% CI: 1.3 to 2.8, p < 0.01) and a further decrease in LVEF within the first year (odds ratio: 3.5, 95% CI: 1.6 to 7.8, p < 0.01).


CONCLUSIONS
The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF.
Claessen
Bimmer E P M
BE
Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
van der Schaaf
René J
RJ
Verouden
Niels J
NJ
Stegenga
Nienke K
NK
Engstrom
Annemarie E
AE
Sjauw
Krischan D
KD
Kikkert
Wouter J
WJ
Vis
Marije M
MM
Baan
Jan
J
Koch
Karel T
KT
de Winter
Robbert J
RJ
Tijssen
Jan G P
JG
Piek
Jan J
JJ
Henriques
José P S
JP
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D002908:Chronic Disease; D015331:Cohort Studies; D054059:Coronary Occlusion / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left