The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction.

Xuanqi An,Yuejin Yang,Jingang Yang,Kefei Dou,Salvatore De Rosa

doi:10.1155/2021/6646804

Abstract

Background The prognostic significance of CTO in the non-IRA in patients with AMI has been under dispute. Relevant long-term follow-up studies are lacking. Hypothesis. CTO in the non-IRA is an independent predictor of poor long-term prognosis in patients with AMI. Methods We prospectively enrolled 2336 patients with AMI who received emergent percutaneous coronary intervention successfully from January 2006 to May 2011. Our primary endpoints included death from cardiovascular causes, recurrent myocardial infarction, stroke, and target-vessel revascularization. We adopted Cox regression analysis adjusted for confounders to analyze the impact of CTO in the non-IRA on long-term mortalities. Results We identified 628 (27.6%) subjects with CTO in the non-IRA among 2282 AMI patients. After a mean follow-up duration of 134.3 months, we found the CTO group had significantly higher MACCE rate than the group without CTO (30.4% versus 24.3%, P=0.004). CTO in the non-IRA independently predicted 11-year MACCE in the male AMI subgroup (hazard ratio 1.28, 95% confidence interval 1.06 to 1.54, P=0.01) and in the male NSTEMI subgroup (hazard ratio 1.53, 95% confidence interval 1.09 to 2.15, P=0.02). In the CTO group, three-vessel disease independently predicted 11 year MACCE (hazard ratio 2.05, 95% confidence interval 1.29 to 3.28, P=0.002). Conclusions Our long-term observational study supported the association between CTO in the non-IRA and poorer prognosis in AMI patients undergoing primary PCI. We identified the group with the three-vessel disease as a high-risk subgroup in patients with CTO in the non-IRA.

Highlights

Acute myocardial infarction (AMI) is the primary cause of death in patients with coronary heart disease (CHD). e introduction of percutaneous coronary intervention (PCI) has identified chronic total occlusion (CTO) of the noninfarct related artery in about 10–30% patients with AMI [1, 2]
Our study aims to evaluate the effects of CTO in the non-IRA on the patients’ total mortality with STEMI or non-ST-segment elevation myocardial infarction (NSTEMI) 11 years after PCI through a long-term follow-up
We discovered that CTO in the non-IRA was an independent predictor of 11-year Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in the male AMI subgroup and in the male NSTEMI subgroup

Summary

Introduction

Acute myocardial infarction (AMI) is the primary cause of death in patients with coronary heart disease (CHD). e introduction of percutaneous coronary intervention (PCI) has identified chronic total occlusion (CTO) of the noninfarct related artery in about 10–30% patients with AMI [1, 2]. E introduction of percutaneous coronary intervention (PCI) has identified chronic total occlusion (CTO) of the noninfarct related artery in about 10–30% patients with AMI [1, 2]. Opinions divide on the prognostic impact of CTO in the non-IRA on the patients with AMI due to conflicting results produced by different follow-up studies [2,3,4,5]. The longest follow-up duration is 6 years, and the majority of the study population confines to patients with ST-segment elevation myocardial infarction (STEMI) [6, 7]. Our study aims to evaluate the effects of CTO in the non-IRA on the patients’ total mortality with STEMI or non-ST-segment elevation myocardial infarction (NSTEMI) 11 years after PCI through a long-term follow-up

Materials and Methods

Results

Conclusions