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Collaterals to CTO associated with survival in STEMI
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Well-developed collaterals to a chronic total occlusion in a noninfarct-related artery were linked to improved survival in patients with STEMI, researchers reported.
In a study of 413 patients with STEMI and a single concomitant CTO in a noninfarct-related artery, 5-year survival was significantly better in patients with well-developed collaterals to the CTO — present in 53% of patients — compared with those with poorly developed collaterals (74% vs. 63%; P = .01). Further, results demonstrated an independent association between well-developed collaterals and improved survival (HR = 1.5; 95% CI, 1.03-2.1). A trend toward improved survival with increasing collateral grade was also noted (P = .09).
Several factors were associated with poorly developed collaterals to the CTO, according to the data, including cardiogenic shock (HR = 1.8; 95% CI, 1.11-3.07), CTO location in the left circumflex artery (HR = 1.9; 95% CI, 1-3.43), CTO diameter 2.5 mm (HR = 2.1; 95% CI, 1.07-4.12) and CTO tapering (HR = 1.9; 95% CI, 1.21-2.85).
The study included consecutive patients with symptoms of an acute MI lasting 30 minutes to 12 hours, an ECG with ST-segment elevation > 1 mm in at least two contiguous leads and a CTO in a noninfarct-related artery. All patients (mean age, 65 years; 74% men; 24% with cardiogenic shock) had successful treatment of the culprit lesion with primary PCI and angiography sufficient to assess the collateral circulation. Patients with multiple CTOs were excluded.
“Further research is needed to assess if the positive effect of collaterals is also true for elective stable CTO patients. Furthermore, it remains unknown whether the presence of collaterals is a biologically modifiable marker or just a prognostic indicator of outcome,” the researchers wrote.
“At a time of ongoing debate regarding the benefit of PCI vs. medical therapy for CTOs, and the optimal selection of patients and lesions to intervene on, this study contributes to our understanding of the clinical outcomes of patients with CTOs,” C. Michael Gibson, MD, and Serge Korjian, MD, both from Beth Israel Deaconess Medical Center and Harvard Medical School, wrote in an accompanying editorial.
Randomized data from a forthcoming trial may provide more evidence regarding treatment for CTOs, they wrote.
“The EuroCTO trial should address this question and potentially shed light on what patient populations would benefit more from invasive intervention,” Gibson and Korjian wrote. – by Melissa Foster
Disclosure: One researcher reports receiving research grants from Abbott Vascular and Abiomed. Gibson and Korjian report no relevant financial disclosures.
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