Impact of successful staged revascularization of a chronic total occlusion in the non-infarct-related artery on long-term outcome in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND

Recently, a chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA) was reported as an independent predictor of clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the clinical significance of staged revascularization for a CTO in the non-IRA for patients with STEMI.

METHODS

A total of 136 patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI) received staged revascularization (ranging 7-10 days) for a CTO in the non-IRA. Cardiac mortality and major adverse cardiac events (MACE) including death, recurrent myocardial infarction, repeat revascularization, and re-hospitalization because of heart failure during 2-year follow-up were recorded.

RESULTS

Recanalization of totally occluded lesions in the non-IRA was successful in 87 (64%) patients for 93 lesions but failed in 49 (36%) patients. During 2-year follow-up, cardiac mortality was lower (8.0% vs. 20.4%, p = 0.036) and MACE-free survival was higher (78.2% vs. 61.2%, p = 0.042) in patients with successful than in those with failed revascularization of a CTO in the non-IRA. Multivariable analysis showed that after adjustment for possible confounders, successful recanalization of a CTO in the non-IRA was an independent predictor for 2-year cardiac mortality (HR = 0.145, 95% CI 0.047-0.446, P = 0.001) and MACE-free survival (HR = 0.430, 95%CI 0.220-0.838, P = 0.013).

CONCLUSION

Successful revascularization of a CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.