Chronic total occlusion in a non-infarct-related artery is closely associated with increased five-year mortality in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (from the CREDO-Kyoto AMI registry)

Abstract

Aims: We sought to investigate the clinical impact of chronic total occlusion (CTO) in a non-infarct-related artery (IRA) on long-term cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI).

Methods and results: Among 5,429 patients enrolled in the CREDO-Kyoto AMI registry, the current study population consisted of 2,045 STEMI patients with multivessel disease (MVD) who underwent primary PCI within 24 hours after symptom onset. The cumulative five-year, 30-day and 30-day to five-year incidences of all-cause death were all significantly higher in the CTO group than in the non-CTO group (37.0% versus 22.0%, log-rank p<0.0001, 12.8% versus 6.3%, log-rank p<0.0001, and 28.2% versus 16.8%, log-rank p<0.0001, respectively). The adjusted risk for all-cause death in the CTO group was significantly higher during the entire five years, during the initial 30 days, and beyond 30 days and up to five years (hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.18-1.84, p=0.0009; HR: 1.49, 95% CI: 1.04-2.13, p=0.03; and HR: 1.61, 95% CI: 1.23-2.07, p=0.0006, respectively).

Conclusions: CTO in a non-IRA was associated with increased five-year mortality in STEMI patients with MVD. This was consistently seen even after excluding early deaths within 30 days of the index STEMI event.