Chronic total occlusion in non-infarct-related artery is associated with increased short-and long-term mortality in patients with ST-segment elevation acute myocardial infarction complicated by cardiogenic shock (from the CREDO-Kyoto AMI registry).

Abstract

We aimed to investigate the effect of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on short- and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock (CS). Previous studies show contradictory results about the clinical effect of CTO in non-IRA on short-term mortality in STEMI patients with CS. From the CREDO-Kyoto AMI registry enrolling 5429 patients, the current study population consisted of 313 STEMI patients with multivessel disease complicated by CS who underwent primary PCI for the nonleft main coronary artery culprit lesion within 24 hr after onset. They were divided according to the presence of CTO (CTO group: N = 100 and non-CTO group: N = 213). Hemodynamic compromise was more profound in the CTO group as suggested by the more frequent use of intra-aortic balloon pumping and/or extracorporeal membrane oxygenation. Infarct size estimated by the peak creatine phosphokinase level was larger in the CTO group than in the non-CTO group. The cumulative 30-day and 5-year incidences of all-cause death were significantly higher in the CTO group than in the non-CTO group (34.0% vs 18.0%, P = 0.001, and 64.5% vs 46.0%, P = 0.0001). After adjusting for confounders, the excess risk of the CTO group relative to the non-CTO group for all-cause death remained significant both at 30days and at 5years (hazard ratio [HR]: 2.05, 95% confidence interval [CI]: 1.27-3.29, P = 0.003, and HR: 1.90, 95% CI: 1.34-2.69, P = 0.0004). In STEMI patients complicated by CS, CTO in non-IRA was associated with increased 30-day and 5-year mortality.