Non-infarct Artery After Primary PCI in Acute STEMI
Non-infarct Artery After Primary PCI in Acute STEMI
Aims. We aimed to assess the impact of a non-infarct related artery (IRA) chronic total occlusion (CTO) on clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in a real-world cohort of patients.
Methods and Results. This is a retrospective observational study of 1435 patients treated at a large single tertiary cardiac center providing a high-volume PPCI service. Patients with coexisting CTO (4.7%) were significantly more likely to have presented in cardiogenic shock and less likely to achieve TIMI 2/3 flow in the IRA post procedure resulting in lower ejection fraction and higher peak troponin-T levels. A concurrent CTO in a non-IRA was associated with higher in-hospital mortality (16.4% vs 3.1%; P<.001), 30-day mortality (19.4% vs 5.9%; P<.001) and long-term mortality (23.9% vs 12.2%; P=.01). Binary logistic regression analysis showed that the presence of a non-IRA CTO was independently predictive of mortality at 30 days (odds ratio, 3.2; 95% confidence interval, 1.2–8.1) but not for long-term mortality.
Conclusion. The presence of a coexisting CTO in patients undergoing PPCI for STEMI is associated with adverse clinical outcomes; further work is required to improve prognosis in these patients, which may include early staged revascularization of the non-IRA CTO.
Primary percutaneous coronary intervention (PCI) has improved the short- and long-term clinical outcomes in patients with ST-elevation myocardial infarction. However, subgroups of patients continue to have higher than desirable mortality rates. In particular, observational studies have shown worse outcomes in patients presenting with multi-vessel disease including a non-infarct related artery (non-IRA) chronic total occlusion (CTO). However, it remains unclear whether any additional clinical benefit is derived from multivessel revascularization in the acute setting. This is reflected in international guidance discouraging PCI of non-IRA lesions at the time of primary PCI.
The aim of this retrospective study is to evaluate the impact of a non-IRA CTO on short- and long-term clinical outcomes in a real-world population of patients undergoing primary PCI at a single tertiary center in the United Kingdom.
Abstract and Introduction
Abstract
Aims. We aimed to assess the impact of a non-infarct related artery (IRA) chronic total occlusion (CTO) on clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in a real-world cohort of patients.
Methods and Results. This is a retrospective observational study of 1435 patients treated at a large single tertiary cardiac center providing a high-volume PPCI service. Patients with coexisting CTO (4.7%) were significantly more likely to have presented in cardiogenic shock and less likely to achieve TIMI 2/3 flow in the IRA post procedure resulting in lower ejection fraction and higher peak troponin-T levels. A concurrent CTO in a non-IRA was associated with higher in-hospital mortality (16.4% vs 3.1%; P<.001), 30-day mortality (19.4% vs 5.9%; P<.001) and long-term mortality (23.9% vs 12.2%; P=.01). Binary logistic regression analysis showed that the presence of a non-IRA CTO was independently predictive of mortality at 30 days (odds ratio, 3.2; 95% confidence interval, 1.2–8.1) but not for long-term mortality.
Conclusion. The presence of a coexisting CTO in patients undergoing PPCI for STEMI is associated with adverse clinical outcomes; further work is required to improve prognosis in these patients, which may include early staged revascularization of the non-IRA CTO.
Introduction
Primary percutaneous coronary intervention (PCI) has improved the short- and long-term clinical outcomes in patients with ST-elevation myocardial infarction. However, subgroups of patients continue to have higher than desirable mortality rates. In particular, observational studies have shown worse outcomes in patients presenting with multi-vessel disease including a non-infarct related artery (non-IRA) chronic total occlusion (CTO). However, it remains unclear whether any additional clinical benefit is derived from multivessel revascularization in the acute setting. This is reflected in international guidance discouraging PCI of non-IRA lesions at the time of primary PCI.
The aim of this retrospective study is to evaluate the impact of a non-IRA CTO on short- and long-term clinical outcomes in a real-world population of patients undergoing primary PCI at a single tertiary center in the United Kingdom.
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