title: Impact of chronic total coronary occlusion on microvascular reperfusion in patients with a first anterior ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  We investigated an impact of the presence of chronic total coronary occlusion (CTO) in a non-infarct related coronary artery on microvascular reperfusion in patients with a first anterior ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI).
  
  
  METHODS
  In accordance with the presence or absence of CTO in a non-infarct related coronary artery, we analyzed Thrombolysis in Myocardial Infarction myocardial perfusion (TMP) grade on a scale of 0 to 3, with higher scores indicating better perfusion, and ST-segment resolution in sum of lead I, aVL, and V1 through V6 to evaluate microvascular reperfusion in a total of 140 consecutive patients with a first anterior STEMI.
  
  
  RESULTS
  We identified CTO in 15 patients (11% of total). The incidence of impaired microvascular reperfusion was greater in patients with CTO vs without CTO, defined as TMP grades 0 or 1 together with <30% ST-segment resolution (33% vs 6%, respectively; P=.0006) and the enzymatic infarct was larger (10304 ± 8060 IU/L vs 6804 ± 4959 IU/L; P=.009). Logistic regression analysis revealed that CTO is closely associated with incidental impaired microvascular reperfusion (odds ratio, 6.801; 95% confidence interval, 1.284-36.209; P=.024).
  
  
  CONCLUSIONS
  The presence of CTO in a non-infarct related coronary artery might confer a considerable disadvantage upon microvascular reperfusion and result in adverse clinical outcomes of PCI for a first anterior STEMI.
authors.affiliation: Section of Cardiology, Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan. suzuki-m@m.ehime-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Daijirou
authors.initials: D
authors.lastname: Enomoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mizobuchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kazatani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Honda
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications*; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome