title: Defining the prognosis of chronic total occlusions during primary percutaneous coronary intervention.
abstract: BACKGROUND
  The influence of coexisting collateral circulation between chronic total occlusion (CTO) and infarct-related artery (IRA) in patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. We aimed to investigate the impact of coexisting collateral circulation between CTO and IRA on early clinical outcomes in patients with acute STEMI.
  
  
  METHODS
  A total of 1488 consecutive acute STEMI patients who underwent primary percutaneous coronary intervention were prospectively included in the study. After restoration of antegrade flow, the patients who had coexisting CTO and collateral supply from IRA were defined as the CTO-IRA-related (CIR) group (n=56). Patients with coexisting CTO but with no collateral supply from IRA were defined as the CTO-IRA-unrelated (CIUR) group (n=104). Patients without coexisting CTO were defined as the non-CTO group (n=1328).
  
  
  RESULTS
  Compared with the CIUR and non-CTO groups, the CIR group was significantly associated with higher Killip class of at least 2 (P<0.001) at presentation, a lower rate of postprocedural thrombolysis in myocardial infarction 2/3 flow (P<0.001), and myocardial perfusion grade 3 (P<0.001). Moreover, the CIR group had significantly higher in-hospital (P<0.001) and 30-day mortality (P<0.001). On multivariate regression analysis, the CIR group (odds ratio=15.96, 95% confidence interval=4.94-51.54; P<0.001) as well as age, post-PCI TIMI, Killip and NT-proBNP levels were independently associated with 30-day mortality. However, the CIUR group was not an independent predictor of early clinical outcomes.
  
  
  CONCLUSIONS
  After restoration of antegrade flow, coexisting CTO supplied by IRA collaterals has unfavourable effects on procedural success, enzymatic infarct size and postprocedural haemodynamic conditions. These collaterals are also independent predictors of 30-day mortality in acute STEMI patients.
authors: aDepartment of Cardiology, Adana Numune Training and Research Hospital, Adana bDepartment of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors: Ömer
authors: Ö
authors: Şen
authors: Fatih
authors: F
authors: Şen
authors: Mustafa
authors: M
authors: Topuz
authors: Samir
authors: S
authors: Allahverdiyev
authors: Ahmet O
authors: AO
authors: Baykan
authors: Oğuz
authors: O
authors: Akkuş
authors: Zehra
authors: Z
authors: Sümbül
authors: Murat
authors: M
authors: Çaylı
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome