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Simple clinical criteria indicated CTOs in noninfarct-related arteries
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Long-term survival was independently associated with multivessel disease, left ventricular ejection fraction and renal function, but not with chronic total occlusion in patients presenting with STEMI, study results found.
Researchers conducted a single-center, retrospective, observational study of 2,020 consecutive patients referred with STEMI among patients with single-vessel disease, multivessel disease (MVD) without CTO, with one CTO or with multiple CTOs to investigate the predictors and effect on long-term survival of one or more CTOs in patients with STEMI.
Independent clinical predictors for the presence of CTO included: cardiogenic shock (OR=5.05; 95% CI, 3.29-7.64); prior MI (OR=2.06; 95% CI, 1.35-3.09); aged older than 65 years (OR=1.94; 95%, CI 1.40-2.71); and history of angina (OR=1.94; 95% CI, 1.29-2.87). Mortality was higher in patients with multiple CTOs (76.5%) vs. those with one CTO (28.1%) or without CTO (7.3%; P<.0001).
After adjustment for LVEF and renal function, MVD was an independent predictor for 1-year mortality (HR=1.81; 95% CI, 1.18-2.77), but CTO was not (HR=1.07; 95% CI, 0.66-1.73).
According to the researchers, one or more CTOs in noninfarct-related artery confers a worse prognosis, but adjusting for LVEF and renal function showed that 1-year survival was independently associated with the presence of MVD with or without CTO, but not CTO per se.
“[W]e believe that CTO is still a marker of disease severity, as CTO was an independent predictor of lower LVEF after the index STEMI,” they wrote. “For the first time, we also report that the risk of mortality in patients with multiple CTOs in non-infarct-related arteries is exceedingly high.”
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