Incidence and clinical impact of concurrent chronic total occlusion according to gender in ST-elevation myocardial infarction.
OBJECTIVE
To determine the prevalence of a concurrent CTO in men and women and to examine its impact on mortality.


BACKGROUND
The impact of chronic total occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) according to gender has not been assessed.


METHODS
Patients referred with STEMI were categorized into single vessel disease (SVD), multivessel disease (MVD) without, with 1 or > 1 CTO. The primary end-point was the 1-year mortality.


RESULTS
Among the 2020 STEMI patients included between 2006 and 2011, 24% were female. Women were older, had more hypertension and renal failure (P < 0.0001 for all). The prevalence of 1 or > 1 concurrent CTO was similar in both sexes, 7 and 1%, respectively. Early and late mortality was significantly higher in women compared with men (P < 0.0001). In women, the mortality was significantly worse in patients with > 1 CTO (100%) and with 1 CTO (36.4%) compared with those with MVD without CTO (18.4%) or with SVD (10.4%) (P < 0.0001). MVD with and without concurrent CTO were both independent predictors of 1-year mortality in women (HR 3.58; 95 % CI 1.69-7.18 and HR 2.76; 95 % CI 1.33-5.51) whereas only MVD with CTO was predictive in men (HR 2.19; 95% CI 1.20-3.97).


CONCLUSIONS
Among unselected STEMI patients, the prevalence of CTO was equal in both sexes whereas early and late mortality remained significantly higher in women. Other factors than the presence of a concurrent CTO must be explored to explain differences in survival after STEMI between women and men.
Department of Cardiology, Quebec Heart-Lung Institute, Quebec City, Canada.
Yoann
Y
Bataille
Jean-Pierre
JP
Déry
Éric
É
Larose
Eltigani
E
Abdelaal
Jimmy
J
Machaalany
Josep
J
Rodés-Cabau
Stéphane
S
Rinfret
Ugo
U
Déry
Olivier
O
Costerousse
Louis
L
Roy
Olivier F
OF
Bertrand
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors