Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 168, Issue 1, Pages 250-254Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2012.09.086
Keywords
Chronic total occlusion; Non-ST-segment elevation myocardial infarction; Percutaneous coronary interventions; 12-month mortality
Categories
Funding
- Polish Ministry of Health
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Background: Three-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to assess the impact on 12-month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease. Methods: The study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. The patients with prior coronary artery bypass grafting and those with significant stenosis of the left main coronary artery were excluded. The 12-month mortality was obtained from a government database. Results: Of the 925 patients fulfilling the inclusion and exclusion criteria, 438 (47.4%) patients had 1 or more CTO of a major non-IRA coronary artery (+CTO), and 487 (52.6%) patients had 3-vessel disease without CTO (-CTO). The in-hospital mortality for the +CTO and -CTO patients was 5.3% and 2.1%, respectively (p=0.009), whilst the 12-month mortality was 21.1% and 11.9%, respectively (p=0.0001). After multivariate adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk=1.42, 95% CI=1.01-2.00, p=0.047). Conclusions: The presence of CTO in non-IRA in patients with NSTEMI and 3-vessel coronary disease predicts higher 12-month mortality. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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