Chronic total occlusion intervention of the non-infarct-related artery in acute myocardial infarction patients: the Korean multicenter chronic total occlusion registry. Issue 6 (September 2018)

• Record Type: Journal Article
• Authors: Park, Ji Young; Choi, Byoung Geol; Rha, Seung-Woon; Kang, Tae Soo; Choi, Cheol Ung; Yu, Cheol Woong; Gwon, Hyeon-Cheol; Chae, In-Ho; Kim, Hyo-Soo; Park, Hun Sik; Lee, Seung-Hwan; Kim, Moo-Hyun; Hur, Seung-Ho; Jang, Yangsoo
• Is Part Of: Coronary artery disease. Volume 29:Issue 6(2018:Sep.)
• Publication Date: 2018-09
• Subjects: acute myocardial infarction -- chronic total occlusion -- percutaneous coronary intervention; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000630
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: The Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes. Patients and methods: Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group ( n =321) and the failed CTO-PCI group ( n =101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model. Results: After the PSM analysis, two propensity-matched groups (85 pairs, n =170) were generated and the baseline characteristics were balanced. The incidence of total death ( P =0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P =0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P =0.048). In the subgroup analysis, the Kaplan–Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality. Conclusion: In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.