Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction.
BACKGROUND
The association between cardiogenic shock and 1 or >1 chronic total occlusion (CTO) in unselected patients presenting with ST-elevation myocardial infarction (MI) (STEMI) has not been characterized.


METHODS
Patients with STEMI referred with or without cardiogenic shock were categorized into no CTO, 1 CTO, and >1 CTO. The primary end point was the 30-day mortality.


RESULTS
Between 2006 and 2011, 2,020 consecutive patients were included. A total of 141 patients (7%) presented with cardiogenic shock on admission. The prevalence of 1 CTO and >1 CTO in a non-infarct-related artery was 23% and 5%, respectively, among patients with shock compared with 6% and 0.5% in patients without shock (P < .0001). Independent predictors of cardiogenic shock included left main-related MI (odds ratio [OR] 6.55, 95% CI 1.39-26.82, P = .019), CTO (OR 4.20, 95% CI 2.64-6.57, P < .001), creatinine clearance <60 mL/min (OR 3.41, 95% CI 2.32-4.99, P < .0001), and left anterior descending-related MI (OR 2.20, 95% CI 1.51-3.23, P < .0001). Thirty-day mortality was 100% in shock patients with >1 CTO, 65.6% with 1 CTO, and 40.2% in patients without CTO (P < .0001). After adjustment for left ventricular ejection fraction and renal function, CTO remained an independent predictor for 30-day mortality (hazard ratio [HR] 1.83; 95% CI 1.10-3.01, P = .02).


CONCLUSIONS
In patients with STEMI, CTO was strongly associated with cardiogenic shock on admission. In this setting, mortality was substantially higher in patients with 1 CTO and exceedingly high in those with >1 CTO. The presence of CTO was an independent predictor of early mortality.
Quebec Heart-Lung Institute, Quebec, Canada.
Yoann
Y
Bataille
Jean-Pierre
JP
Déry
Éric
É
Larose
Ugo
U
Déry
Olivier
O
Costerousse
Josep
J
Rodés-Cabau
Onil
O
Gleeton
Guy
G
Proulx
Eltigani
E
Abdelaal
Jimmy
J
Machaalany
Can M
CM
Nguyen
Bernard
B
Noël
Olivier F
OF
Bertrand
D000368:Aged; D054059:Coronary Occlusion / Q000150:complications / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality*