The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock

Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of ~850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 ± 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%, p = 0.218). Reperfusion therapy increased from 22.5% in 1989–1993 to 85.4% in 2014–2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%, p < 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84–0.99; p = 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%, p = 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85–0.99; p = 0.030). Short- and long-term mortality trends in patients aged ≥ 75 years remained ~75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to ~50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age.

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TCT-235: Impact of a Concurrent Chronic Total Occlusion on Long-Term Mortality in Patients with Diabetes Mellitus After ST Elevation Myocardial Infarction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.08.257 ◽

2009 ◽

Vol 104 (6) ◽

pp. 90D

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Chronic Total Occlusion ◽

St Elevation Myocardial Infarction ◽

Total Occlusion ◽

Patients With Diabetes ◽

St Elevation ◽

Long Term Mortality

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TCT-377: The impact of the Location of a Chronic Total Occlusion in Conjunction with the Location of the Infarct Related Artery on Long-term Mortality in STElevation Myocardial Infarction Patients

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2011.10.382 ◽

2011 ◽

Vol 58 (20) ◽

pp. B102-B103

Keyword(s):

Myocardial Infarction ◽

Chronic Total Occlusion ◽

Total Occlusion ◽

Infarct Related Artery ◽

The Impact ◽

Long Term Mortality

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Evaluation of the Effect of Concurrent Chronic Total Occlusion and Successful Staged Revascularization on Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction

The Scientific World JOURNAL ◽

10.1155/2014/756080 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Guoxiang Shi ◽

Pengcheng He ◽

Yuanhui Liu ◽

Yaowang Lin ◽

Xing Yang ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Chronic Total Occlusion ◽

Early Mortality ◽

Primary Pci ◽

Total Occlusion ◽

The Impact ◽

Long Term Mortality

Aims. To investigate the impact of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on the long-term prognosis and evaluate the clinical significance of staged revascularization in patients with ST-segment elevation myocardial infarction (STEMI).Methods. 1266 STEMI patients with primary percutaneous coronary intervention (PCI) were categorized as single-vessel disease (SVD), multivessel disease (MVD) without and with CTO. We study the clinical outcomes of patients after primary PCI in the following 3 years. Additionally, patients with CTO received staged revascularization, and major adverse cardiac events (MACE) during 3-year follow-up were recorded.Results. Presence of CTO was a predictor of both early mortality [hazard ratio (HR) 3.4, 95% confidence interval (CI) 2.4–4.5,P<0.01] and late mortality (HR 1.9, 95% CI 1.4–3.6,P<0.01), whereas MVD without CTO was only a predictor of early mortality (HR 1.7, 95% CI 1.3–2.3,P<0.05). In CTO group, 100 patients had successful CTO recanalization, and 48 patients failed. During 3-year follow-up, patients with failed procedure had higher cardiac mortality (22.9% versus 9.0%,P=0.020) and lower MACE-free survival (50.0% versus 72.0%,P=0.009) compared to patients with successful procedure.Conclusion. The presence of CTO and not MVD alone is associated with long-term mortality. Successful revascularization of CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.

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