The long-term impact of a chronic total occlusion in a non-infarct-related artery on acute ST-segment elevation myocardial infarction after primary coronary intervention

• DOI: 10.1186/s12872-021-01874-1
• Publication Date: 2021-01-30T12:02:46Z
• Authors: Yu Liu; Le-Feng Wang; Xin-Chun Yang; Chang-Lin Lu; Kui-Bao Li; Mu-Lei Chen; Na Li; Hong-Shi Wang; Jiu-Chang Zhong; Li Xu; Zhu-Hua Ni; Wei-Ming Li; Kun Xia; Da-Peng Zhang; Hao Sun; Zong-Sheng Guo; Yong-Hui Chi; Ji-Fang He; Zhi-Yong Zhang; Feng Jiang; Hong-Jiang Wang
• Keywords: Male; Time Factors; Risk Assessment; Percutaneous coronary intervention; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; Risk Factors; Diseases of the circulatory (Cardiovascular) system; Humans; Renal Insufficiency; Aged; Retrospective Studies; Age Factors; Acute ST segment elevation myocardial infarction; Middle Aged; Prognosis; 3. Good health; Chronic total occlusion; Peptic Ulcer Hemorrhage; Treatment Outcome; Coronary Occlusion; RC666-701; Chronic Disease; ST Elevation Myocardial Infarction; Female; Research Article

Abstract Objectives To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality.

Methods The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared.

Results The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47–10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO.

Conclusions The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.