title: Impact of chronic total occlusion revascularization in patients with acute myocardial infarction treated by primary percutaneous coronary intervention.
abstract: Coronary chronic total occlusion (CTO) carries a poor outcome in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). We sought to investigate the prognostic impact of a staged successful CTO-PCI in patients with AMI treated with primary PCI. Outcome analysis included consecutive patients treated by successful primary PCI with coexisting non-infarct-related artery CTO who survived after 1 week from AMI. A comparison between patients with successful CTO-PCI and patients with failed or nonattempted CTO-PCI was performed. The primary end points of the study were 1-year and 3-year cardiac survival. Of 1,911 patients who underwent successful primary PCI for AMI from 2003 to 2012, 169 (10%) had non-infarct-related artery CTO of a major branch. A staged CTO-PCI attempt was performed in 74 patients (44%) and was successful in 58 (success rate 78%). All patients with successful CTO-PCI received drug-eluting stents. In the successful CTO-PCI group, a complete coronary revascularization was achieved in 88% of the patients. The 1-year cardiac mortality rate was 1.7% in the successful CTO-PCI group and 12% in nonattempted or failed CTO-PCI group (p = 0.025). Successful CTO-PCI was an independent predictor of 3-year cardiac survival (hazard ratio 0.20, 95% confidence interval 0.05 to 0.92, p = 0.038). In conclusion, successful CTO-PCI in survivors after primary PCI is associated with improved long-term cardiac survival.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marrani
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Cantini
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Ruben
authors.initials: R
authors.lastname: Vergara
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Cerisano
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy. Electronic address: david.antoniucci@virgilio.it.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome