Evaluation of the effect of concurrent chronic total occlusion and successful staged revascularization on long-term mortality in patients with ST-elevation myocardial infarction.
OBJECTIVE
To investigate the impact of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on the long-term prognosis and evaluate the clinical significance of staged revascularization in patients with ST-segment elevation myocardial infarction (STEMI).


METHODS
1266 STEMI patients with primary percutaneous coronary intervention (PCI) were categorized as single-vessel disease (SVD), multivessel disease (MVD) without and with CTO. We study the clinical outcomes of patients after primary PCI in the following 3 years. Additionally, patients with CTO received staged revascularization, and major adverse cardiac events (MACE) during 3-year follow-up were recorded.


RESULTS
Presence of CTO was a predictor of both early mortality [hazard ratio (HR) 3.4, 95% confidence interval (CI) 2.4-4.5, P < 0.01] and late mortality (HR 1.9, 95% CI 1.4-3.6, P < 0.01), whereas MVD without CTO was only a predictor of early mortality (HR 1.7, 95% CI 1.3-2.3, P < 0.05). In CTO group, 100 patients had successful CTO recanalization, and 48 patients failed. During 3-year follow-up, patients with failed procedure had higher cardiac mortality (22.9% versus 9.0%, P = 0.020) and lower MACE-free survival (50.0% versus 72.0%, P = 0.009) compared to patients with successful procedure.


CONCLUSIONS
The presence of CTO and not MVD alone is associated with long-term mortality. Successful revascularization of CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Guoxiang
G
Shi
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Pengcheng
P
He
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Yuanhui
Y
Liu
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Yaowang
Y
Lin
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Xing
X
Yang
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Jiyuan
J
Chen
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Yingling
Y
Zhou
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Ning
N
Tan
D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D013997:Time Factors; D014652:Vascular Diseases / Q000150:complications