title: The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock.
abstract: OBJECTIVE
  To evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS).
  
  
  RESULTS
  A total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5-year follow-up with a landmark set at 30 days. In patients without CS (n = 4409), only MVD with a CTO was an independent predictor for 30-day [hazard ratio (HR) 2.8, P < 0.01] and 5-year mortality (HR 1.7, P < 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients (n = 609), MVD with and without a CTO were independent predictors for 30-day mortality (HR 2.2, P < 0.01 and HR 1.8, P < 0.01). In 30-day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P = 0.06).
  
  
  CONCLUSIONS
  In non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality.
authors.affiliation: Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Loes P
authors.initials: LP
authors.lastname: Hoebers
authors.forename: Marije M
authors.initials: MM
authors.lastname: Vis
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: René J
authors.initials: RJ
authors.lastname: van der Schaaf
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Kikkert
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000503:physiopathology*; D054059:Coronary Occlusion / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000503:physiopathology; D013318:Stroke Volume; D016277:Ventricular Function, Left