Abstract 3659: The Impact of Multivessel Disease on Long-term Mortality in Patients with ST-elevation Myocardial Infarction is due to the Presence of a Chronic Total Occlusion
Background: In acute ST-elevation myocardial infarction (STEMI), patients with multivessel disease (MVD) are considered to be a subgroup with an increased risk of mortality compared with patients with single vessel disease (SVD).
Methods and results: To evaluate the impact of MVD on one-year mortality in patients with STEMI we studied 1417 consecutive STEMI patients, admitted between 1997 and 2002, all treated with primary percutaneous coronary intervention (PCI). Furthermore we hypothesized that the impact of MVD on mortality is entirely due to the presence of a chronic total occlusion (CTO) in a non infarct related artery. Patients with MVD and/or with a CTO had multiple differences in baseline and angiographic characteristics, all associated with worse outcome. Mortality in patients with SVD, MVD and a CTO was 8%, 16% and 35% respectively. After correction for the baseline differences, MVD was an independent predictor of mortality (OR 1.5; 95%CI 1.1–2.1). However, when CTO was included in the model, MVD was no longer an independent predictor for mortality, whereas CTO was a strong and independent predictor for one-year mortality in STEMI patients treated with PCI (OR 3.8;9 95%CI 2.5–5.8).
Conclusions: We conclude that STEMI patients with MVD have a higher one-year mortality rate compared with patients with SVD. The higher mortality rate is mainly determined by the presence of a CTO in a non-infarct related artery. In the setting of primary PCI the presence of a CTO, and not the mere presence of MVD, is an independent predictor of one-year mortality.