title: Impact of a chronic total occlusion in a non-infarct related artery on clinical outcomes following primary percutaneous intervention in acute ST-elevation myocardial infarction.
abstract: OBJECTIVE
  We aimed to assess the impact of a non-infarct related artery (IRA) chronic total occlusion (CTO) on clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in a real-world cohort of patients.
  
  
  RESULTS
  This is a retrospective observational study of 1435 patients treated at a large single tertiary cardiac center providing a high-volume PPCI service. Patients with coexisting CTO (4.7%) were significantly more likely to have presented in cardiogenic shock and less likely to achieve TIMI 2/3 flow in the IRA post procedure resulting in lower ejection fraction and higher peak troponin-T levels. A concurrent CTO in a non-IRA was associated with higher in-hospital mortality (16.4% vs 3.1%; P<.001), 30-day mortality (19.4% vs 5.9%; P<.001) and long-term mortality (23.9% vs 12.2%; P=.01). Binary logistic regression analysis showed that the presence of a non-IRA CTO was independently predictive of mortality at 30 days (odds ratio, 3.2; 95% confidence interval, 1.2-8.1) but not for long-term mortality.
  
  
  CONCLUSIONS
  The presence of a coexisting CTO in patients undergoing PPCI for STEMI is associated with adverse clinical outcomes; further work is required to improve prognosis in these patients, which may include early staged revascularization of the non-IRA CTO.
authors.affiliation: The Essex Cardiothoracic Centre, Nethermayne, Essex, SS16 5NL United Kingdom. ammozid@hotmail.com.
authors.forename: Abdul M
authors.initials: AM
authors.lastname: Mozid
authors.forename: Shah
authors.initials: S
authors.lastname: Mohdnazri
authors.forename: Nilanka N
authors.initials: NN
authors.lastname: Mannakkara
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Robinson
authors.forename: Rohan
authors.initials: R
authors.lastname: Jagathesan
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Sayer
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Aggarwal
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Clesham
authors.forename: Reto A
authors.initials: RA
authors.lastname: Gamma
authors.forename: Kare H
authors.initials: KH
authors.lastname: Tang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kelly
authors.forename: John R
authors.initials: JR
authors.lastname: Davies
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D054059:Coronary Occlusion / Q000150:complications* / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom