Abstract
Little is known about the prevalence and clinical impact of chronic total occlusion (CTO) in patients with acute ST-elevation myocardial infarction with (STEMI) undergoing primary percutaneous coronary intervention (PCI). Our objective was to evaluate the prevalence and impact on 1-year mortality of CTO in non-infarct related coronary artery (IRA) in patients with STEMI referred for primary PCI. Consecutive patients referred for primary PCI were identified from our data-base and were categorized into NO CTO, 1 CTO and > 1 CTO groups. All angiograms were prospectively analyzed. The primary end-point was mortality at 1 year. Fom 5/2006 to 5/2009, we identified 1094 patients. The prevalence of NO CTO, 1 CTO and > 1CTO was 91.8%, 7.2% and 1%, respectively. Patients with CTO were older (P = 0.0058) but there was no significant difference in other traditional risk factors between groups. Patients with CTO had more frequently a previous history of MI (P < 0.0001), unstable angina (P < 0.0001) and stable angina (P = 0.0002). Patients with CTO presented more often in Killip class IV (P < 0.0001) and with decreased renal function (P = 0.026). The prevalence of 3-vessel disease was higher in patients with 1 CTO (32%), and with > 1CTO (90%) compared to NO CTO (4.1%) (P < 0.0001). After adjustment for differences in clinical and angiographic characteristics, the presence of CTO remained an independent predictor of 1-year mortality (HR: 1.75 95% CI, 1.00-3.05, P = 0.048). The prevalence of CTO in non-IRA in STEMI patients referred for primary PCI was 8.2%. Compared to patients with NO CTO, mortality at 1 year was higher in patients with 1 CTO and exceedingly high in patients with > 1CTO. After adjustment, the presence of CTO remained a strong independent predictor of 1-year mortality. Therapeutic options in these STEMI patients with CTO in non-IRA need to be further defined.
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