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• W2333665706 abstract "Background: In spite of recent advances in the treatment of ST-segment elevation acute myocardial infarction (STEMI), some groups of patients still experience considerable morbidity and mortality after a STEMI. Previous reports showed conflicting results regarding the prognostic impact of a chronic total occlusion (CTO) in a non infarct-related artery (IRA). Purposes: To analyze the prevalence and the clinical impact of a CTO in a non-IRA in patients with STEMI treated with primary percutaneous coronary intervention (PCI). Methods: We prospectively included all patients with STEMI that underwent primary PCI at our institution from October 2009 to April 2012. Results: 1176 patients were included in the study. Among these patients, 125 (10,6%) had at least one CTO in a non-IRA. Patients with a CTO were older (mean age 65,3 vs 61,6 years; p 0,002), had higher prevalence of diabetes (32% vs 23,1%; p 0,028), hypertension (67,2% vs 52,8%; p 0,002), previous myocardial infarction (25,6% vs 8,8%; p 0,001) and showed worse renal function (mean creatinine clearance 81,8 ml/min vs 95,1 ml/min; p 0,005). The presence of a CTO was associated with worse hemodynamic status at admission (cardiogenic shock 6,4% vs 2,6%), more frequent requirements of in-hospital invasive procedures (such as intra-aortic balloon pump or invasive mechanical ventilation) and worse left ventricular function at hospital discharge (mean left ventricular ejection fraction 43,9% vs 52%; p 0,001). In-hospital mortality was significantly higher in patients with CTO (6,4% vs 2,7%; p 0,047). Mean follow up was 339 days. During the follow up, patients with a CTO had a significantly higher overall mortality (HR 2.79, CI 95% 1.71-4.56; p 0.001), especially due to non-cardiac causes (HR 3.83; 95% CI 2.10-7.01; p 0.001). We did not find a significant association between CTO and cardiac mortality in our patients (HR 1.86; 95% CI 0.82-4.21; p 0.138). In the multivariate analysis, including Killip class at admission and left ventricular ejection fraction, the presence of a CTO was not associated with increased total mortality (HR 1.04; 95% CI 0.55-1.94; p 0,921). Conclusions: In non-selected patients with STEMI treated with primary PCI, the presence of a CTO in a non-IRA identifies a group of patients at higher risk, with more co-morbidities and worse clinical outcome both during the index hospitalization and the follow up. At follow up, the higher mortality of patients with CTO was mainly due to non-cardiac causes. The presence of a CTO was not an independent predictor of mortality in our series." @default.
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• W2333665706 date "2013-08-02" @default.
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• W2333665706 title "Clinical impact of a chronic total oclusion in a non-infarct-related coronary artery in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention" @default.
• W2333665706 doi "https://doi.org/10.1093/eurheartj/eht308.p1306" @default.
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