Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention

Bimmer E.P.M. Claessen, René J. van der Schaaf, Niels J. Verouden, Nienke K. Stegenga, Annemarie E. Engstrom, Krischan D. Sjauw, Wouter J. Kikkert, Marije M. Vis, Jan Baan, Karel T. Koch, Robbert J. de Winter, Jan G.P. Tijssen, Jan J. Piek, José P.S. Henriques

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Abstract

Objectives: The aim of this study was to evaluate the effect of a concurrent chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) on long-term mortality and left ventricular ejection fraction (LVEF). Background: The impact of a CTO in a non-infarct-related artery (IRA) on prognosis after STEMI is unknown. Methods: Between 1997 and 2005, we admitted 3,277 STEMI patients treated with primary percutaneous coronary intervention. Patients were categorized as single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with a CTO in a non-IRA. We performed a "landmark survival analysis" to 5 years follow-up with a landmark set at 30 days. Additionally, we analyzed the evolution of LVEF within 1 year. Results: Of the patients, 2,115 (65%) had SVD, 742 patients (23%) had MVD without CTO, and 420 patients (13%) had a concurrent CTO. Presence of a CTO was a strong and independent predictor for 30-day mortality (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.6 to 4.7, p < 0.01), whereas MVD without CTO was a weak predictor (HR: 1.6, 95% CI: 1.2 to 2.2, p = 0.01). In 30-day survivors, CTO remained a strong predictor (HR: 1.9, 95% CI: 1.4 to 2.8, p < 0.01), and MVD lost its independent prognostic value (HR: 1.1, 95% CI: 0.8 to 1.5, p = 0.45). Furthermore, CTO was associated with LVEF ≤40% immediately after STEMI (odds ratio: 1.9, 95% CI: 1.3 to 2.8, p < 0.01) and a further decrease in LVEF within the first year (odds ratio: 3.5, 95% CI: 1.6 to 7.8, p < 0.01). Conclusions: 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.

Original languageEnglish
Pages (from-to)1128-1134
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume2
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

Keywords

  • chronic total occlusion
  • left ventricular function
  • mortality
  • myocardial infarction
  • prognosis

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