title: Impact of successful staged revascularization of a chronic total occlusion in the non-infarct-related artery on long-term outcome in patients with acute ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Recently, a chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA) was reported as an independent predictor of clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the clinical significance of staged revascularization for a CTO in the non-IRA for patients with STEMI.
  
  
  METHODS
  A total of 136 patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI) received staged revascularization (ranging 7-10 days) for a CTO in the non-IRA. Cardiac mortality and major adverse cardiac events (MACE) including death, recurrent myocardial infarction, repeat revascularization, and re-hospitalization because of heart failure during 2-year follow-up were recorded.
  
  
  RESULTS
  Recanalization of totally occluded lesions in the non-IRA was successful in 87 (64%) patients for 93 lesions but failed in 49 (36%) patients. During 2-year follow-up, cardiac mortality was lower (8.0% vs. 20.4%, p = 0.036) and MACE-free survival was higher (78.2% vs. 61.2%, p = 0.042) in patients with successful than in those with failed revascularization of a CTO in the non-IRA. Multivariable analysis showed that after adjustment for possible confounders, successful recanalization of a CTO in the non-IRA was an independent predictor for 2-year cardiac mortality (HR = 0.145, 95% CI 0.047-0.446, P = 0.001) and MACE-free survival (HR = 0.430, 95%CI 0.220-0.838, P = 0.013).
  
  
  CONCLUSIONS
  Successful revascularization of a CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.
authors.affiliation: Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China.
authors.forename: Zhen Kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Rui Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Feng Hua
authors.initials: FH
authors.lastname: Ding
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome