title: The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients.
abstract: OBJECTIVE
  Several studies have evaluated the impact of a CTO on short- and long-term mortality in STEMI patients. It has been speculated that the adverse effect on prognosis could differ per coronary location. The purpose of this study was to evaluate whether the long-term prognosis of STEMI patients differs according to the coronary location of the CTO.
  
  
  RESULTS
  Between 2000 and 2012, a total of 480 STEMI patients with a CTO in a non-infarct-related artery were included. The primary outcome for the present analysis was three-year all-cause mortality, evaluating the impact of the coronary CTO and infarct location. Four hundred and thirteen patients had a single CTO in a non-infarct-related artery, whereas 67 patients had more than one CTO and in this group mortality was higher. In patients with a single CTO, the highest risk of mortality was observed when the culprit lesion was located in the LAD or proximal LCX or when the CTO lesion was located in the proximal LAD.
  
  
  CONCLUSIONS
  We previously reported that STEMI patients with a CTO have a worse prognosis than STEMI patients without a CTO. We now show that, in these patients, LAD or proximal LCX location for the culprit lesion, or proximal LAD location for the CTO lesion, is associated with the highest risk. As a result, almost all CTO patients are at increased risk for mortality due to the combination of the culprit and CTO artery location.
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Loes P C
authors.initials: LP
authors.lastname: Hoebers
authors.forename: Joëlle
authors.initials: J
authors.lastname: Elias
authors.forename: Ivo M
authors.initials: IM
authors.lastname: van Dongen
authors.forename: Dagmar M
authors.initials: DM
authors.lastname: Ouweneel
authors.forename: Bimmer E P M
authors.initials: BE
authors.lastname: Claessen
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Jose P S
authors.initials: JP
authors.lastname: Henriques
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001158:Arteries / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*