Several observational studies have compared clinical outcome in patients with a co-existing
noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without,
suggesting increased all-cause mortality. The goal of this study was to provide a
systematic review and meta-analysis evaluating the impact of the presence of an n-IRA
CTO on short- and long-term mortality after primary percutaneous coronary intervention.
Studies published from January 1980 to January 2014 that compared the incidence of
all-cause mortality in patients with ST-segment elevation myocardial infarction with
co-existing n-IRA CTO versus those without were identified using an electronic search
and reviewed using meta-analytical techniques. Seven studies (5 observational studies
and 2 observational analyses of randomized controlled trials) comprising 14,117 patients
and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO
was associated with increased incidence of all-cause mortality at a median follow-up
of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk
23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p
<0.0001). This finding was consistent in the analysis of studies reporting 30-day
follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p <0.0001).
Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis
of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23,
95% CI 1.90 to 2.63; p <0.0001). In conclusion, coronary CTO in the nonculprit artery
in patients presenting with ST-segment elevation myocardial infarction is associated
with increased short- and long-term all-cause mortality.
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References
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J. 2012; 33: 2569-2619
- Outcome of urgent percutaneous transluminal coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease.Am Heart J. 1992; 124: 1427-1433
- Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group.Am Heart J. 1991; 121: 1042-1049
- Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy.Heart. 2006; 92: 1760-1763
- Cardiogenic shock complicating acute myocardial infarction prognostic impact of early and late shock development.Eur Heart J. 2003; 24: 258-265
- Primary percutaneous coronary intervention in patients with acute myocardial infarction, resuscitated cardiac arrest, and cardiogenic shock: the role of primary multivessel revascularization.J Am Coll Cardiol Interv. 2013; 6: 115-125
- Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial.Eur Heart J. 2012; 33: 768-775
- The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock.Eur J Heart Fail. 2013; 15: 425-432
- Impact of chronic total occlusions on markers of reperfusion, infarct size, and long-term mortality: a substudy from the TAPAS-trial.Catheter Cardiovasc Interv. 2011; 77: 484-491
- Prognostic impact of a chronic occlusion in a noninfarct vessel in patients with acute myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention.J Invasive Cardiol. 2006; 18: 16-19
- Impact of a chronic total occlusion in a non-infarct related artery on clinical outcomes following primary percutaneous intervention in acute ST-elevation myocardial infarction.J Invasive Cardiol. 2014; 26: 13-16
- Prevalence, predictors and clinical impact of unique and multiple chronic total occlusion in non-infarct-related artery in patients presenting with ST-elevation myocardial infarction.Heart. 2012; 98: 1732-1737
- Incidence and clinical impact of concurrent chronic total occlusion according to gender in ST-elevation myocardial infarction.Catheter Cardiovasc Interv. 2013; 82: 19-26
- Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction.Heart. 2010; 96: 1968-1972
- Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention.J Am Coll Cardiol Interv. 2009; 2: 1128-1134
- Deadly association of cardiogenic shock and chronic total occlusion in acute ST-elevation myocardial infarction.Am Heart J. 2011; 164: 509-515
- Effect of multivessel coronary disease with or without concurrent chronic total occlusion on one-year mortality in patients treated with primary percutaneous coronary intervention for cardiogenic shock.Am J Cardiol. 2010; 105: 955-959
- Effect of multivessel coronary artery disease with or without a concomitant chronic total occlusion on 1-year survival in patients treated with rescue angioplasty.J Invasive Cardiol. 2013; 25: 64-68
- Impact of multivessel coronary disease with chronic total occlusion on one-year mortality in patients with acute myocardial infarction.Korean Circ J. 2012; 42: 95-99
- Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction.Am J Cardiol. 2012; 109: 208-213
- Chronic total occlusion angioplasty in the United States.JACC Cardiovasc Interv. 2009; 2: 479-486
- Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.Trials. 2010; 11: 89
Article Info
Publication History
Published online: April 06, 2015
Accepted:
March 24,
2015
Received in revised form:
March 24,
2015
Received:
January 7,
2015
Footnotes
See page 13 for disclosure information.
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Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
