TCT-371 Impact of Chronic Total Occlusions on Mortality in Patients Presenting With Cardiac Arrest

Abstract

Conclusions: Our data demonstrates that PTs with STEMI and a CTO have higher inhospital, 30 day, and one year mortalities than STEMI PTs without a CTO. PTs with NSTEACS and a CTO have higher in-hospital and 30 day mortality than NSTEACS PTs without a CTO, and there is a non-significant trend towards increased one year mortality for PTs with a CTO. Strategies to reduce this increased mortality are needed.Background: Cardiac arrest (CA) is often the result of both acute and chronic coronary artery disease (CAD) particularly when it is caused by ventricular tachycardia or fibrillation (VT/VF). Therapeutic hypothermia has been shown to decrease mortality and after resuscitated CA (rCA). It has been demonstrated that a chronic total occlusion (CTO) in the non-infarct artery in patients (Pts) with ST segment elevation myocardial infarction (STEMI) is associated with increased mortality. The incidence and effect of CTOs in Pts with rCA has not been well described. Further the incidence and effect of CTOs in rCA Pts as the result of STEMI is unknown. Methods: The Minneapolis Heart Institute has developed formalized protocols for both STEMI (Level One, L1) and cardiac arrest and sequential therapeutic hypothermia (CoolIt). From 2006-May 2012, 164 sequential Pts who had been enrolled in the Cool-It program who presented with VT/VF and underwent angiography were evaluated for the presence of at least one CTO in a major coronary vessel. From 2006-May 2012, 121 PTs who had been enrolled in the Cool-It program and underwent angiography but also suffered from STEMI were also evaluated for CTOs. In-hospital, 30 day, and 1 year mortality were compared between Pts who did and did not have CTO. STEMI Pts who presented with rCA were compared to STEMI Pts without rCA for the presence of a CTO. Results: See table below:Conclusions: These data demonstrate that rCA Pts presenting with VT/VF and who have a CTO appear to have similar mortality compared to those without a CTO. Pts with and without a CTO who presented with rCA and STEMI have similar mortality although there is a trend in favor of those without a CTO. STEMI Pts with rCA have a higher incidence of a CTO than do STEMI Pts without rCA. Further efforts to understand, treat, and avoid CA in Pts with a CTO are warranted. TCT-372"Full metal jacket" (stented length > or [ 50 mm) using drug-eluting stents for chronic total occlusive lesions.Background: Limited data exists on patients who have undergone drug eluting stent (DES) implantation of long chronic total occlusive (CTO) lesion in native coronary arteries. Methods: We defined long continuous stent implantation (stent length > or ¼ 50 mm) as "full metal jacket" (FMJ). From April 2007 to March 2013, 344 consecutive patients (361 lesions) who underwent FMJ using any DESs for de novo lesion were enrolled. Subjects were classified into two groups: the patients with CTO lesion (CTO group, 113 patients, 114 lesions) and without CTO lesion (non-CTO group, 239 patients, 247 lesions). The two groups were compared for mean 24AE19 months c...