Impact of Multivessel Coronary Disease With Chronic Total Occlusion on One-Year Mortality in Patients With Acute Myocardial Infarction

Abstract

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.

Prognostic value of the age, creatinine, and ejection fraction score for non‐infarct‐related chronic total occlusion revascularization after primary percutaneous intervention in acute ST‐elevation myocardial infarction patients: A retrospective study

“…Acute STEMI patients with non‐IRA CTO often have a bad early and late clinical outcome in spite of successful primary PCI . CTO in a non‐IRA was independently associated with late mortality in STEMI patients complicated by cardiogenic shock .…”

“…Patients with acute ST‐segment elevation myocardial infarction (STEMI) often have chronic total occlusion (CTO) lesions in the non‐infarct‐related coronary arteries (non‐IRA). In the setting of primary percutaneous coronary intervention (PCI) for STEMI, previous studies have suggested that an increased rate of poor early and late outcomes are observed in patients with CTO in non‐IRA . With current techniques and equipment, the probability of reopening a CTO by PCI has substantially increased in these high clinical risk patients.…”

Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

“…In recently published paper Cetin et al [20] demonstrated that after successful opening of the occluded vessel, ECG markers of ventricular repolarization inhomogeneity significantly improved, as compared with the pre-PCI values. Lee et al [21] reported that in 60 out of 88 patients with CTO, in whom an attempt of PCI was made after the acute phase of MI, the procedure was successful in 40 (67%) patients. There were no deaths during follow-up in this successful group, while in patients in whom PCI failed or was not attempted death occurred in 23% (p = 0.001).…”

Predictors and Clinical Implications of Minimal ST-Segment Elevation in Patients with ST-Segment Elevation Myocardial Infarction

“…Furthermore, ischemic heart disease can promote collateral circulation [9]. A prognostic benefit of collateral circulations in acute MI has been previously proposed [13,14,15]. …”