Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Lesiak, Maciej; Cugowska, Monika; Araszkiewicz, Aleksander; Grygier, Marek; Pyda, Małgorzata; Skorupski, Włodzimierz; Mitkowski, Przemysław; Łanocha, Magdalena; Grajek, Stefan

doi:10.5603/cj.a2016.0112

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…ird, nearly 84% of our study population were male. Although this might not reflect the real world, this phenomenon did prevail across other previous studies [2,6,7,11,12,20]. And our result showed the predictive capability of CTO in the non-IRA only in the male subgroup.…”

Section: Limitationscontrasting

confidence: 41%

“…Similarly, Ariza-Sole et al contended CTO in the non-IRA did not act as an independent predictor of 1-year mortality on 1176 STEMI patients [2]. Lesiak et al performed the longest 6-year follow-up study on 836 STEMI patients and supported CTO in the non-IRA's predictive role [6]. Last but not least, O'Connor et al carried out a meta-analysis encompassing 11451 STEMI patients from 7 observational studies and showed CTO in the non-IRA was independently associated with increased mortality at a mean follow-up of 25.2 months [13].…”

Section: Discussionmentioning

confidence: 99%

“…Opinions divide on the prognostic impact of CTO in the non-IRA on the patients with AMI due to conflicting results produced by different follow-up studies [2][3][4][5]. Also, the longest follow-up duration is 6 years, and the majority of the study population confines to patients with ST-segment elevation myocardial infarction (STEMI) [6,7]. Our study aims to evaluate the effects of CTO in the non-IRA on the patients' total mortality with STEMI or non-ST-segment elevation myocardial infarction (NSTEMI) 11 years after PCI through a long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

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The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction

Yang

Dou

et al. 2021

Journal of Interventional Cardiology

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Background. The prognostic significance of CTO in the non-IRA in patients with AMI has been under dispute. Relevant long-term follow-up studies are lacking. Hypothesis. CTO in the non-IRA is an independent predictor of poor long-term prognosis in patients with AMI. Methods. We prospectively enrolled 2336 patients with AMI who received emergent percutaneous coronary intervention successfully from January 2006 to May 2011. Our primary endpoints included death from cardiovascular causes, recurrent myocardial infarction, stroke, and target-vessel revascularization. We adopted Cox regression analysis adjusted for confounders to analyze the impact of CTO in the non-IRA on long-term mortalities. Results. We identified 628 (27.6%) subjects with CTO in the non-IRA among 2282 AMI patients. After a mean follow-up duration of 134.3 months, we found the CTO group had significantly higher MACCE rate than the group without CTO (30.4% versus 24.3%, P = 0.004 ). CTO in the non-IRA independently predicted 11-year MACCE in the male AMI subgroup (hazard ratio 1.28, 95% confidence interval 1.06 to 1.54, P = 0.01 ) and in the male NSTEMI subgroup (hazard ratio 1.53, 95% confidence interval 1.09 to 2.15, P = 0.02 ). In the CTO group, three-vessel disease independently predicted 11 year MACCE (hazard ratio 2.05, 95% confidence interval 1.29 to 3.28, P = 0.002 ). Conclusions. Our long-term observational study supported the association between CTO in the non-IRA and poorer prognosis in AMI patients undergoing primary PCI. We identified the group with the three-vessel disease as a high-risk subgroup in patients with CTO in the non-IRA.

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Section: Limitationscontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction

Yang

Dou

et al. 2021

Journal of Interventional Cardiology

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The Presence of Chronic Total Occlusion in Noninfarct-Related Arteries Is Associated With Higher Mortality and Worse Patient Outcomes Following Percutaneous Coronary Intervention for STEMI: A Systematic Review, Meta-Analysis and Meta-Regression

Goyal,

Maheshwari,

Shahbaz

et al. 2024

Cardiology in Review

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Reperfusion therapy with percutaneous coronary intervention improves outcomes in patients with ST-elevation myocardial infarction. We conducted a meta-analysis to assess the impact of chronic total occlusion (CTO) in noninfarct-related artery on the outcomes of these patients. Comprehensive searches were performed using PubMed, Google Scholar, and EMBASE. The primary endpoint was the 30-day mortality rate, with secondary endpoints including all-cause mortality, repeat myocardial infarction, and stroke. Forest plots were created for the pooled analysis of the results, with statistical significance set at P < 0.05. A total of 19 studies were included in this meta-analysis, with 23,989 patients (3589 in CTO group and 20,400 in no-CTO group). The presence of CTO was associated with significantly higher odds of 30-day mortality [18.38% vs 5.74%; relative risk (RR), 3.69; 95% confidence intervals (CI), 2.68–5.07; P < 0.00001], all-cause mortality (31.00% vs 13.40%; RR, 2.79; 95% CI, 2.31–3.37; P < 0.00001), cardiovascular-related deaths (12.61% vs 4.1%; RR, 2.61; 95% CI, 1.99–3.44; P < 0.00001), and major adverse cardiovascular events (13.64% vs 9.88%; RR, 2.08; 95% CI, 1.52–2.86; P < 0.00001) than the non-CTO group. No significant differences in repeated myocardial infarction or stroke were observed between the CTO and non-CTO groups. Our findings underscore the need for further research on the benefits and risks of performing staged or simultaneous percutaneous coronary intervention for CTO in the noninfarct-related artery in patients with ST-elevation myocardial infarction.

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Successful revascularization of noninfarct related artery with chronic total occlusion among acute myocardial infarction patients

Tong

Yu²,

Li³

et al. 2018

Medicine

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Background:Randomized trials and meta-analyses demonstrated that chronic total occlusion (CTO) in noninfarct related artery (n-IRA) was associated with increased all-cause mortality. Recently, several observational studies suggested that the successful revascularization of n-IRA with CTO decreased all-cause mortality.Methods:A systematic search was performed in Cochrane Controlled Trials Registry, PubMed, MEDLINE, and EMBASE databases for relevant studies. Article assessing the prognostic role of revascularization of n-IRA with CTO was enrolled in this meta-analysis. Data and characteristics of each study were extracted. A meta-analysis was performed to generate pooled odds ratio (OR) and 95% confidence intervals (95% CIs) for outcomes. The primary outcome was major adverse cardiac events (MACE). Beg funnel plot was used to evaluate publication bias.Results:Four observational studies and one randomized controlled trial involving 1083 patients were enrolled for analysis. Compared with nonreperfusion, the successful percutaneous coronary intervention (PCI) of n-IRA with CTO was related to decreased all-cause mortality (OR was 0.34, and 95% CI was 0.2–0.59; P = .0001).Conclusions:Successful PCI of n-IRA with CTO could significantly decrease all-cause mortality, cardiac mortality, MACE, and stroke in acute myocardial infarction patients. In addition, it was not associated with the increased risk of repeat revascularization and myocardial infarction.

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Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction

Cited by 4 publications

References 21 publications

The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction

The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction

The Presence of Chronic Total Occlusion in Noninfarct-Related Arteries Is Associated With Higher Mortality and Worse Patient Outcomes Following Percutaneous Coronary Intervention for STEMI: A Systematic Review, Meta-Analysis and Meta-Regression

Successful revascularization of noninfarct related artery with chronic total occlusion among acute myocardial infarction patients

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