Prognostic impact of non-culprit chronic total occlusion over time in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Issue 9 (21st June 2021)

• Record Type: Journal Article
• Authors: Milasinovic, Dejan; Mladenovic, Djordje; Zaharijev, Stefan; Mehmedbegovic, Zlatko; Marinkovic, Jelena; Jelic, Dario; Zobenica, Vladimir; Radomirovic, Marija; Dedovic, Vladimir; Pavlovic, Andrija; Dobric, Milan; Stojkovic, Sinisa; Asanin, Milika; Vukcevic, Vladan; Stankovic, Goran
• Is Part Of: European heart journal. Volume 10:Issue 9(2021)
• Page Start: 990
• Page End: 998
• Publication Date: 2021-06-21
• Subjects: Myocardial infarction -- Percutaneous coronary intervention; 616.1205
• DOI: 10.1093/ehjacc/zuab041
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Aims: Previous studies indicated that a chronic total occlusion (CTO) in a non-infarct-related artery is linked to higher mortality mainly in the acute setting in patients with ST-elevation myocardial infarction (STEMI). Our aim was to assess the temporal distribution of mortality risk associated with non-culprit CTO over years after STEMI. Methods and results: The study included 8679 STEMI patients treated with primary percutaneous coronary intervention (PCI). Kaplan–Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with log-rank test, with landmarks set at 30 days and 1 year. Adjusted Cox regression models were constructed to assess the impact of non-culprit CTO on mortality over different time intervals. Tests for interaction were pre-specified between non-culprit CTO and acute heart failure and left ventricular ejection fraction. The primary outcome variable was all-cause mortality, and the median follow-up was 5 years. Non-culprit CTO was present in 11.6% of patients ( n = 1010). Presence of a CTO was associated with increased early [30-day adjusted hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54–2.36; P < 0.001] and late mortality (5-year adjusted HR 1.66, 95% CI 1.42–1.95; P < 0.001). Landmark analyses revealed an annual two-fold increase in mortality in patients with vs. without a CTO after the first year of follow-up. The observed pattern of mortality increase over time was independent of acute or chronic LV impairment. Conclusions: Non-culprit CTO is independently associated with mortality over 5 years after primary PCI for STEMI, with a constant annual two-fold increase in the risk of death beyond the first year of follow-up. Graphical Abstract: