Introduction:
Presence of Chronic Total Occlusion (CTO) in patients with Acute Myocardial Infarction (AMI) undergoing Percutaneous Coronary Intervention (PCI) has not been studied previously.
Hypothesis:
To study in-hospital mortality & resource utilization of AMI patients undergoing PCI associated with presence of CTO.
Methods:
We queried National Inpatient Sample from October 2015 - December 2017 using ICD 10 codes to identify patients over 18 years of age who underwent PCI & had AMI with presence or absence of CTO. SAS 9.4 was used for univariate and multivariate analysis. Propensity score matching was performed to matched CTO vs Non-CTO group’s baseline characteristics & Elixhauser comorbidities with Absolute standardized difference of 10% as matching limit.
Results:
A total of 576760 patients were identified who underwent PCI with AMI, out of which 525535 (91.12%) had no CTO while 51225(8.8%) had CTO. Each matched group contains 51210 patients. The In-hospital mortality was significantly higher in AMI PCI patients with CTO compared to Non-CTO (4.7% vs 3%,
p
<0.0001). Length of hospital stay was higher in CTO patients (median 2 vs 3,
p
=0.001) and less percentage of patients were discharged to home (78.8% vs 81.1%,
p
<0.0001). Median cost of hospital stay was higher in CTO group (20921$ vs 19856$,
p
<.0001).
Conclusions:
Analysis of this large database of patients undergoing PCI with AMI suggests that presence of CTO results in higher In-hospital mortality, with longer hospital stay & higher cost. Future observational studies should be directed towards CTO based outcomes in AMI patients undergoing PCI.
CHRONIC TOTAL OCCLUSION IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE MYOCARDIAL INFARCTION: A NATIONWIDE STUDY USING THE NATIONAL INPATIENT SAMPLE (NIS) 1999-2014
