The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF.

Primary percutaneous coronary intervention for ST elevation myocardial infarction in octogenarians: trends and outcomes Claessen, B.E.P.M.; Kikkert, W.J.; Engstrom, A.E.; Hoebers, L.P.; Damman, P.; Vis, M.M.; Koch, K.T.; Baan, J.,Jr; Meuwissen, M.; van der Schaaf, R.J.; de Winter, R.J.; Tijssen, J.G.; Piek, J.J.; Henriques, J.P. General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. In the total cohort of 379 patients, 30-day mortality was 21% (81 patients) and 1-year mortality was 28% (107 patients). There was no improvement in survival among octogenarian STEMI patients over the 11-year study period. Conclusion The annual proportion of octogenarian STEMI patients increased significantly over the 11-year study period. Mortality among these high-risk patients was high and did not improve during the study period. Unfortunately, little is known about the optimal treatment of the elderly as they are underrepresented in many randomised clinical trials. Further studies into the optimal STEMI management strategy for the elderly are warranted.

AimsTo evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS). Methods and resultsA total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5-year follow-up with a landmark set at 30 days. In patients without CS (n ¼ 4409), only MVD with a CTO was an independent predictor for 30-day [hazard ratio (HR) 2.8, P , 0.01] and 5-year mortality (HR 1.7, P , 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients (n ¼ 609), MVD with and without a CTO were independent predictors for 30-day mortality (HR 2.2, P , 0.01 and HR 1.8, P , 0.01). In 30-day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P ¼ 0.06). ConclusionIn non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality.--