CTO in noninfarct-related artery ups risk for death in non-STEMI patients

Issue: March 2012

CRT 2012

WASHINGTON — Non-STEMI patients with a chronic total occlusion in an artery unrelated to the infarct are at an increased risk for death, according to data presented at the Cardiovascular Research Technologies 2012 meeting.

“There have been several reports on chronic total occlusions in noninfarct-related arteries in the STEMI population, which have associated them with an increase in mortality,” Truls Råmunddal, MD, PhD, of Sahlgrenska University Hospital in Gothenburg, Sweden, said during a presentation. “However, we have no data regarding chronic total occlusions in noninfarct-related arteries in the non-STEMI population.”

Råmunddal and colleagues evaluated data from 17,730 patients with non-STEMI in the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR). From 2005 to 2010, the researchers divided non-STEMI patients from SCAAR into two groups based on the presence or absence of a chronic total occlusion (CTO) in a noninfarct-related artery. According to results, there were 1,620 patients with CTO in a noninfarct-related artery. These patients tended to be older, had more extensive CAD and more CV risk factors.

Kaplan-Meier curves showed that patients with a CTO in a noninfarct-related artery had substantially higher mortality, ranging up to 37%. After adjustment for several known confounders, CTO appeared to be an independent predictor of long-term mortality, with an HR of 1.69, Råmunddal said.

In an additional analysis, the researchers separated patients into three groups: those with single-vessel disease, those with multivessel disease without a CTO and those with multivessel disease with a CTO. They then performed an analysis with a landmark set at 30 days. At 30 days, mortality was 2.2% in patients with single-vessel disease, 2.8% in patients with multivessel disease without a CTO and 4.3% in patients with multivessel disease with a CTO. After adjustment, data suggested that multivessel disease both with and without a CTO in noninfarct-related arteries were independent predictors for mortality, with HRs of 2.82 and 1.79, respectively.

Råmunddal said the curves continued to diverge over time. After exclusion of patients who died within the first 30 days, mortality was highest — up to 39% — in patients with multivessel disease with a CTO in a noninfarct-related artery.

Data also indicated that multivessel disease with and without CTO are independent predictors for long-term mortality, with HRs of 2.8 and 1.79, respectively, when compared with single-vessel disease — a finding that is somewhat different from mortality reported in the STEMI population, where multivessel disease without CTO in noninfarct-related arteries does not seem to be an predictor of long-term mortality, according to Råmunddal.

“Patients with non-STEMI and concurrent chronic total occlusion in noninfarct-related arteries have substantially higher long-term mortality,” he said. “Multivessel disease with and without chronic total occlusion in the noninfarct-related arteries are both independent predictors of both short- and long-term mortality in the non-STEMI population. [The next step] is to determine whether chronic total occlusion revascularization of noninfarct-related arteries in non-STEMI will improve long-term survival.” – by Melissa Foster

For more information:

Råmunddal T. iMPACT Trial: Impact of chronic total occlusion in noninfarct-related artery on mortality in non-STEMI. Presented at: Cardiovascular Research Technologies 2012; Feb. 4-7, 2012; Washington.

Disclosure: Dr. Råmunddal reports no relevant financial disclosures.

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