Abstract
ObjectivesTo investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality.MethodsThe enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared.ResultsThe rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47–10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO.ConclusionsThe presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.
Highlights
Previous studies have shown that approximately 40%– 60% of patients with acute ST-segment elevation myocardial infarction (STEMI) have multivessel diseases (MVD), and the long-term prognosis of these patients is worseLiu et al BMC Cardiovasc Disord (2021) 21:59 than that of patients with single-vessel lesions [1,2,3,4]
The incidences of old myocardial infarction (OMI), renal insufficiency, and in-hospital pulmonary infection were significantly higher in the chronic total occlusion (CTO) group than they were in the non-CTO group (P < 0.05)
The results of coronary angiography showed that there was no significant difference in the distribution of culprit vessels in the two groups (P > 0.05), but the proportion of three-vessel lesions was significantly higher in the CTO group than it was in the non-CTO group (P < 0.05) (Tables 1, 2)
Summary
Previous studies have shown that approximately 40%– 60% of patients with acute ST-segment elevation myocardial infarction (STEMI) have multivessel diseases (MVD), and the long-term prognosis of these patients is worse. Liu et al BMC Cardiovasc Disord (2021) 21:59 than that of patients with single-vessel lesions [1,2,3,4]. Of the patients with STEMI and MVD, approximately 10%–15% have a chronic total occlusion (CTO) in a noninfarct-related artery (IRA), and these patients have an even worse prognosis [5,6,7]. This study examined the factors that can impact the long-term outcome of patients with STEMI and MVD by using multifactorial analysis to compare patients with and without a CTO. The aim of the study was to provide the evidence necessary to develop reasonable treatment strategies
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