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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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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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.