title: Meta-Analysis of the Impact on Mortality of Noninfarct-Related Artery Coronary Chronic Total Occlusion in Patients Presenting With ST-Segment Elevation Myocardial Infarction.
abstract: Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis evaluating the impact of the presence of an n-IRA CTO on short- and long-term mortality after primary percutaneous coronary intervention. Studies published from January 1980 to January 2014 that compared the incidence of all-cause mortality in patients with ST-segment elevation myocardial infarction with co-existing n-IRA CTO versus those without were identified using an electronic search and reviewed using meta-analytical techniques. Seven studies (5 observational studies and 2 observational analyses of randomized controlled trials) comprising 14,117 patients and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO was associated with increased incidence of all-cause mortality at a median follow-up of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk 23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p <0.0001). This finding was consistent in the analysis of studies reporting 30-day follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p <0.0001). Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23, 95% CI 1.90 to 2.63; p <0.0001). In conclusion, coronary CTO in the nonculprit artery in patients presenting with ST-segment elevation myocardial infarction is associated with increased short- and long-term all-cause mortality.
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France; Department of Cardiology, University Hospital Waterford, Ireland. Electronic address: drstephenoconnor@gmail.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sanguineti
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Loes P
authors.initials: LP
authors.lastname: Hoebers
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Unterseeh
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Department of Cardiology, Institut Cardiovasculaire Paris Stud, Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
mesh_terms: D002908:Chronic Disease; D054059:Coronary Occlusion / Q000401:mortality* / Q000628:therapy; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014481:United States / Q000453:epidemiology