Impact of a CTO in a non-infarct-related artery on long-term mortality in patients undergoing primary PCI. (25th November 2020)

• Record Type: Journal Article
• Authors: Milasinovic, D; Mladenovic, D.J; Jelic, D; Mehmedbegovic, Z; Radomirovic, M; Zobenica, V; Pavlovic, A; Vratonjic, J; Vukcevic, V; Asanin, M; Stankovic, G
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Coronary Intervention: Primary and Acute PCI; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.2565
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Previous studies showed increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery, but long-term data are scarce. Purpose: Our aim was to assess all-cause mortality during 5 years follow-up in patients with a remaining nonculprit CTO after being treated with primary PCI. Methods: The study included 9504 patients admitted for primary PCI during 2009–2019, with available baseline angiography, from an electronic, prospective registry of a high-volume catheterization laboratory. Kaplan Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with the log-rank test, with landmarks set at 30 days and then annually up to 5 years follow-up. Adjusted Cox regression models were constructed to assess 30-day and 5-year mortality risk of a non-culprit CTO. Median follow-up was 1507 days. Results: Nonculprit CTO was present in 13.2% of patients (n=1253). Presence of a nonculprit CTO was associated with older age (64 vs. 61, p<0.001), more frequent history of cardiovascular disease including prior MI (33% vs. 14%, p<0.001), stroke (10.3% vs. 5.9%, p<0.001) and CABG (10.5% vs. 1.5%, p<0.001), higher rates of renal failure (10.7% vs. 4.8%, p<0.001), as well as more often Killip class 2–4 on admission (29% vs. 16%, p<0.001) and a lower ejection fraction (40% vs. 47%, p<0.001). Crude mortality rates were significantly increased in patients with a nonculprit CTO vs. no CTO, at both 30 days (15.7% vs. 5.6%, p<0.001) and 5 years (54.6% vs. 27.9%, p<0.001). After adjusting for the observed baseline differences, nonculprit CTO was still associated with an elevated mortality risk at both 30-days (HR 1.5, CI95% 1.1–1.9, p=0.007) and 5 years (HR 1.6, CI95% 1.4–1.9, p<0.001). Landmark analyses showed continuously increasing risk of mortality in the presence of a nonculprit CTO, as compared with primary PCI-treated patients with no CTO (30 days to 1 year 11.4% vs. 4.9%, p<0.001; 1st to 2nd year of follow-up 6.3% vs. 3.4%, p<0.001; 2nd to 3rd year 6.2% vs. 2.8%, p<0.001; 3rd to 4th year 7.4% vs. 3.0%, p<0.001; and 4th to 5th year 5.2% vs. 3.6%, p=0.1). Conclusions: Presence of a nonculprit CTO is independently associated with 5-year mortality after primary PCI. Importantly, the mortality risk increases continuously with an average annual absolute difference of 3%, in patients with a nonculprit CTO vs. those with no CTO. Funding Acknowledgement: Type of funding source: None