TY - JOUR
T1 - Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention
AU - Claessen, Bimmer E. P. M.
AU - van der Schaaf, René J.
AU - Verouden, Niels J.
AU - Stegenga, Nienke K.
AU - Engstrom, Annemarie E.
AU - Sjauw, Krischan D.
AU - Kikkert, Wouter J.
AU - Vis, Marije M.
AU - Baan, Jan
AU - Koch, Karel T.
AU - de Winter, Robbert J.
AU - Tijssen, Jan G. P.
AU - Piek, Jan J.
AU - Henriques, José P. S.
PY - 2009
Y1 - 2009
N2 - Objectives The aim of this study was to evaluate the effect of a concurrent chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) on long-term mortality and left ventricular ejection fraction (LVEF). Background The impact of a CTO in a non-infarct-related artery (IRA) on prognosis after STEMI is unknown. Methods Between 1997 and 2005, we admitted 3,277 STEMI patients treated with primary percutaneous coronary intervention. Patients were categorized as single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with a CTO in a non-IRA. We performed a "landmark survival analysis" to 5 years follow-up with a landmark set at 30 days. Additionally, we analyzed the evolution of LVEF within 1 year. Results Of the patients, 2,115 (65%) had SVD, 742 patients (23%) had MVD without CTO, and 420 patients (13%) had a concurrent CTO. Presence of a CTO was a strong and independent predictor for 30-day mortality (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.6 to 4.7, p <0.01), whereas MVD without CTO was a weak predictor (HR: 1.6, 95% CI: 1.2 to 2.2, p = 0.01). In 30-day survivors, CTO remained a strong predictor (HR: 1.9, 95% CI: 1.4 to 2.8, p <0.01), and MVD lost its independent prognostic value (HR: 1.1, 95% CI: 0.8 to 1.5, p = 0.45). Furthermore, CTO was associated with LVEF <= 40% immediately after STEMI (odds ratio: 1.9, 95% CI: 1.3 to 2.8, p <0.01) and a further decrease in LVEF within the first year (odds ratio: 3.5, 95% CI: 1.6 to 7.8, p <0.01). Conclusions The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF. (J Am Coll Cardiol Intv 2009;2:1128-34) (C) 2009 by the American College of Cardiology Foundation
AB - Objectives The aim of this study was to evaluate the effect of a concurrent chronic total occlusion (CTO) in patients with ST-segment elevation myocardial infarction (STEMI) on long-term mortality and left ventricular ejection fraction (LVEF). Background The impact of a CTO in a non-infarct-related artery (IRA) on prognosis after STEMI is unknown. Methods Between 1997 and 2005, we admitted 3,277 STEMI patients treated with primary percutaneous coronary intervention. Patients were categorized as single-vessel disease (SVD), multivessel disease (MVD) without CTO, and MVD with a CTO in a non-IRA. We performed a "landmark survival analysis" to 5 years follow-up with a landmark set at 30 days. Additionally, we analyzed the evolution of LVEF within 1 year. Results Of the patients, 2,115 (65%) had SVD, 742 patients (23%) had MVD without CTO, and 420 patients (13%) had a concurrent CTO. Presence of a CTO was a strong and independent predictor for 30-day mortality (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.6 to 4.7, p <0.01), whereas MVD without CTO was a weak predictor (HR: 1.6, 95% CI: 1.2 to 2.2, p = 0.01). In 30-day survivors, CTO remained a strong predictor (HR: 1.9, 95% CI: 1.4 to 2.8, p <0.01), and MVD lost its independent prognostic value (HR: 1.1, 95% CI: 0.8 to 1.5, p = 0.45). Furthermore, CTO was associated with LVEF <= 40% immediately after STEMI (odds ratio: 1.9, 95% CI: 1.3 to 2.8, p <0.01) and a further decrease in LVEF within the first year (odds ratio: 3.5, 95% CI: 1.6 to 7.8, p <0.01). Conclusions The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF. (J Am Coll Cardiol Intv 2009;2:1128-34) (C) 2009 by the American College of Cardiology Foundation
U2 - https://doi.org/10.1016/j.jcin.2009.08.024
DO - https://doi.org/10.1016/j.jcin.2009.08.024
M3 - Article
C2 - 19926056
SN - 1936-8798
VL - 2
SP - 1128
EP - 1134
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 11
ER -