Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial

Claessen, Bimmer E.; Dangas, George; Weisz, Giora; Witzenbichler, Bernhard; Guagliumi, Giulio; Möckel, Martin; Brener, Sorin J.; Xu, Ke; Henriques, José P.S.; Mehran, Roxana; Stone, Gregg W.

doi:10.1093/eurheartj/ehr471

Cited by 210 publications

(139 citation statements)

References 22 publications

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“…I am not truly surprised for the benefit in mortality, because it confirms somehow the data reported in previous observational or post-hoc studies [1][2][3][4][5][6]. I find also clinically unacceptable stating that a treatment is non-inferior to another one, based on a composite endpoint, when its different components move clearly in different directions for each therapeutic option.…”

supporting

confidence: 74%

DECISION-CTO: A “negative” clinical trial? Really?

Gutiérrez‐Chico

Louvard

2017

Cardiol J.

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supporting

confidence: 74%

DECISION-CTO: A “negative” clinical trial? Really?

Gutiérrez‐Chico

Louvard

2017

Cardiol J.

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“…This has been reported both in the setting of stable coronary artery disease and in ST‐segment elevation myocardial infarction patients, with or without cardiogenic shock 2, 3, 4. The underlying mechanism for this poorer prognosis is currently incompletely understood.…”

mentioning

confidence: 99%

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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BackgroundPrevious studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up.Methods and ResultsAll consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy.ConclusionsThe presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.

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“…The idea that patients with acute STEMI and concurrent nIRA CTO would demonstrate clinical benefit from CTO PCI was generated from the apparent 2‐fold increased mortality and morbidity rates among patients with STEMI and multivessel CAD and CTO 4, 5, 21. Even among patients without STEMI, increased mortality has been attributed to the presence of CTOs in nIRAs 3, 6. One of the possible mechanisms of increased mortality in patients with CTO could be a larger infarct size caused by the acute occlusion of a donor artery to CTO.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have shown that the presence of a CTO in an nIRA in patients with STEMI is linked to an increase in short‐ and long‐term mortality 4, 5. Moreover, it has been suggested that the presence of a CTO is associated with worse outcomes compared with the presence of multivessel CAD without a CTO 3, 5, 6. Although there is evidence that multivessel revascularization in patients with STEMI might be beneficial,7 it remains unclear whether revascularization via PCI of an nIRA CTO, and in particular in patients with STEMI, is translated to improved outcomes.…”

mentioning

confidence: 99%

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

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BackgroundStudies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not.Method and ResultsWe conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33).ConclusionsIn this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

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Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial

Abstract: In patients with STEMI undergoing primary PCI in the HORIZONS-AMI trial, MVD with or without a CTO in a non-IRA was an independent predictor of early mortality. The presence of a CTO in a non-IRA was also an independent predictor of increased late mortality to 3 years.

Cited by 210 publications

References 22 publications

DECISION-CTO: A “negative” clinical trial? Really?

DECISION-CTO: A “negative” clinical trial? Really?

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

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