Impact of the Presence of Chronic Total Occlusion in a Non-Infarct-Related Coronary Artery in Acute Myocardial Infarction Patients

Abstract

SummaryChronic total occlusion (CTO) in a non-infarcted-related artery was reported to worsen immediate clinical outcome in acute myocardial infarction (AMI) patients. However, the prognosis of such patients with preserved left ventricular function after successful primary percutaneous coronary intervention (PCI) has not yet been clarified. The aim of the present study was to evaluate whether the presence of CTO contributes to a worse prognosis even in patients with preserved left ventricular function after primary PCI.We retrospectively analyzed 353 consecutive patients with acute myocardial infarction, whose left ventricular ejection fraction (LVEF) was not less than 40% in the echocardiography performed 1 day after primary PCI. We divided the patients into two groups according to the presence (n = 25) or absence (n = 328) of CTO in the non-infarct-related coronary artery, and compared the clinical outcome of patients between the two groups.The LVEF estimated by echocardiography after primary PCI was similar between patients with and without CTO (55.1 ± 8.6% versus 58.0 ± 9.4%; P = 0.07). The peak creatine kinase value was also similar between the two groups (1539 versus 1921 U/L; P = 0.33); however, CTO patients were significantly more likely to undergo intra-aortic balloon pumping (56.0% versus 12.5%; P < 0.001) during primary PCI, and 30-day mortality was significantly higher in CTO patients (12.0% versus 0.9%; P < 0.001). By multivariate analysis, cardiogenic shock at arrival was significantly correlated with 30-day mortality.Even though the LVEF of AMI patients with CTO was preserved after successful PCI, a high mortality rate was observed. (Int Heart J 2015; 56: 592-596) Key words: Chronic total coronary occlusion, Cardiogenic shock C oronary chronic total occlusion (CTO) is commonly found on approximately 15-30% of all diagnostic coronary angiographies (CAGs), in patients with significant coronary artery disease.1,2) Although the treatment of CTO remains a technical challenge and still 20-35% of CTOs are not recanalized by percutaneous coronary intervention (PCI) even when performed by experienced operators, 3,4) successful PCI for CTO has been shown to improve left ventricular (LV) systolic function, reduce angina, increase exercise capacity, and reduce the need for late bypass surgery.3,5,6) On the other hand, CTO patients who were not revascularized had a significantly higher rate of cardiac mortality and sudden cardiac death compared with those who were revascularized. 7,8) Moreover, in acute myocardial infarction (AMI) patients, the presence of CTO in a non-infarct-related artery (IRA) is a strong and independent risk factor for short-and middle-term mortality.9-11) However, it is unclear whether the subset of patients with CTO who present well preserved LV function after primary PCI would show the same results.The aim of this retrospective study was to evaluate the impact of the presence of CTO on the prognosis in the subset of CTO patients complicated with AMI and presenting wellpreserved LV ...

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

“…Smoking for 20 minutes can damage the vascular endothelium and such vasoconstriction obstacles lead to platelet aggregation, the forming of atherosclerosis and an increased risk of STEMI (Zhang et al 2015). Furthermore, another study found that cardiogenic shock and the survival of patients with STEMI after PCI are closely correlated (Mizuguchi et al 2015). Cardiogenic shock is still the leading cause of hospital mortality in patients with STEMI.…”

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

“…[25][26][27] Successful revascularization of coronary CTO is associated with the improvement of left ventricular function in patients with angina pectoris or old myocardial infarction. [28][29][30] Recently, George and colleagues reported that successful CTO intervention was associated with a decrease in mortality as compared to unsuccessful CTO intervention using large registry data (n = 13,443).…”

Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease

“…9) Chronic total occlusion (CTO) was defined as a 100% luminal narrowing in a non-IRA before percutaneous coronary intervention (PCI) without antegrade flow and with antegrade or retrograde filling by collateral vessels. 2,10) Peripheral arterial disease (PAD) was defined as an ankle brachial index (ABI) < 0.9.…”