Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (from the PL-ACS Registry).
BACKGROUND
Three-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to assess the impact on 12-month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease.


METHODS
The study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. The patients with prior coronary artery bypass grafting and those with significant stenosis of the left main coronary artery were excluded. The 12-month mortality was obtained from a government database.


RESULTS
Of the 925 patients fulfilling the inclusion and exclusion criteria, 438 (47.4%) patients had 1 or more CTO of a major non-IRA coronary artery (+CTO), and 487 (52.6%) patients had 3-vessel disease without CTO (-CTO). The in-hospital mortality for the +CTO and -CTO patients was 5.3% and 2.1%, respectively (p=0.009), whilst the 12-month mortality was 21.1% and 11.9%, respectively (p=0.0001). After multivariate adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk=1.42, 95%CI=1.01-2.00, p=0.047).


CONCLUSIONS
The presence of CTO in non-IRA in patients with NSTEMI and 3-vessel coronary disease predicts higher 12-month mortality.
Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Marek
M
Gierlotka
Mateusz
M
Tajstra
Mariusz
M
Gąsior
Michał
M
Hawranek
Tadeusz
T
Osadnik
Krzysztof
K
Wilczek
Dawid
D
Olszowski
Krzysztof
K
Dyrbuś
Lech
L
Poloński
D000368:Aged; D000369:Aged, 80 and over; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome