title: Prevalence, predictors and clinical impact of unique and multiple chronic total occlusion in non-infarct-related artery in patients presenting with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  To investigate the predictors and impact on long-term survival of one chronic total occlusion (CTO) or multiple CTOs in patients presenting with ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  Single-centre retrospective observational study.
  
  
  METHODS
  University-based tertiary referral centre.
  
  
  METHODS
  Between 2006 and 2011, a total of 2020 consecutive patients referred with STEMI were categorised into single vessel disease, multivessel disease (MVD) without CTO, with one CTO or with multiple CTOs.
  
  
  METHODS
  Primary percutaneous coronary intervention.
  
  
  METHODS
  The primary end-point was the 1-year mortality.
  
  
  RESULTS
  The prevalence of single vessel disease, MVD without CTO, with one CTO or with multiple CTOs was 70%, 22%, 7.2% and 0.8%, respectively. Independent clinical predictors for the presence of CTO were cardiogenic shock (OR 5.05; 95% CI 3.29 to 7.64), prior myocardial infarction (OR 2.06; 95% CI 1.35 to 3.09), age >65 years (OR 1.94; 95% CI 1.40 to 2.71) and history of angina (OR 1.94; 95% CI 1.29 to 2.87). Mortality was worse in patients with multiple CTOs (76.5%) compared with those with one CTO (28.1%) or without CTO (7.3%) (p<0.0001). After adjustment for left ventricular ejection fraction and renal function, MVD was an independent predictor for 1-year mortality (HR: 1.81; 95% CI 1.18 to 2.77, p=0.007), but CTO was not (HR: 1.07; 95% CI 0.66 to 1.73, p=0.78).
  
  
  CONCLUSIONS
  Simple clinical factors are associated with the presence of CTO in non-infarct-related artery in patients presenting with STEMI. In these patients, long-term survival was independently associated with MVD, left ventricular ejection fraction and renal function, but not with CTO per se.
authors.affiliation: Quebec Heart-Lung Institute, Quebec, Canada.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Bataille
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Ugo
authors.initials: U
authors.lastname: Déry
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.forename: Jimmy
authors.initials: J
authors.lastname: Machaalany
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors