Background and ObjectivesThe impact of multivessel coronary disease (MVD) with chronic total occlusion (CTO) on one-year mortality in patients with acute myocardial infarction (AMI) is not clearly known. We investigated the impact of MVD with concurrent CTO lesion on one-year mortality in patients with AMI.Subjects and MethodsWe studied 1008 consecutive patients who underwent coronary angiography between November 2005 and December 2008 with a diagnosis of AMI.ResultsAmong 1008 patients, 432 patients (43%) had MVD, and 88 patients (8.7%) had CTO lesion. The one-year overall mortality was higher in patients with MVD than in patients with single vessel disease (SVD) (10.2% vs. 5.9%, p=0.012). However, the one-year overall mortality was not significantly higher in patients with CTO lesion than in patients without that lesion (12.5% vs. 7.3%, p=0.080). In multivariate analysis, independent predictors of one-year overall mortality were age older than 65 years {hazard ratio (HR) 2.41, 95% confidence interval (CI): 1.43 to 4.08}, Killip class ≥III (HR 3.59, 95% CI: 2.24 to 5.77), ST-elevation myocardial infarction (HR 2.45, 95% CI: 1.49 to 4.05) and MVD (HR 1.76, 95% CI: 1.07 to 2.89).ConclusionPatients with MVD showed higher one-year mortality than patients with SVD. However, the presence of CTO was not an independent predictor of one-year mortality in this study that included patients with successfully revascularized CTO lesion.

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Background and Objectives：Development of collateral vessels (CV) of the coronary artery in ischemic heart disease (IHD) differs in each individual. We tried to determine the relationship between the presence of CV and clinical characteristics and CAG findings, and the clinical impact of CV on prognosis. Subjects and Methods： Seventy-one patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) within 24 hours after symptom onset were included. The relationships between the presence of CV and risk factors of IHD and the findings of CAG, and influences of CV on 3-year mortality and cardiac events were evaluated. Results：CV was absent in 35 patients (group A) and was observed in 36 (group B). There was no significant difference between these two groups in clinical characteristics or CAG findings. Risk factors of IHD, other than diabetes and high density lipoprotein-cholesterol (HDL-C), were not different. All seven cases of diabetes were in group A (p=0.005) and HDL-C was higher in group B than group A (41.6±12.0 mg/dL versus 50.1 ±17.3 mg/dL, p=0.021). There was a trend of higher mortality (14.3% versus 2.8%, p=0.056), whereas the higher rate of composite cardiac events in group A during follow-up was statistically significant (45.7% versus 22.2%； hazard ratio, 5.13；95% confidence interval, 1.05-25.04；p=0.043). Conclusion：CV was more frequently observed in the non-diabetic patients and in the patients with higher HDL-C level. The presence of CV in patients with AMI treated with PCI was a favorable prognostic factor.