Abstract 4679: Impact of a Chronic Total Occlusion in a Non-Infarct Related Artery on Long-Term Mortality in Patients With Diabetes Mellitus After ST Elevation Myocardial Infarction
Background: Recently, the presence of a chronic total occlusion (CTO) in a noninfarct-related artery (IRA), and not mere multivessel disease (MVD) was reported to be an independent predictor of mortality after ST-elevation myocardial infarction (STEMI). Patients with diabetes mellitus constitute a patient group with an increased rate of MVD and higher mortality after STEMI. The impact of a CTO in a non-IRA in diabetic patients on long-term mortality is unknown.
Methods: Between 1997 and 2007, we treated 4527 STEMI patients with primary PCI at the Academic Medical Center in Amsterdam. Patients with diabetes were identified from our electronic Cathlab database. We categorized patients as having single vessel disease (SVD), MVD without CTO and CTO. Cox regression was used for multivariate analysis.
Results: A total of 534 patients (12% of the total population) were diabetic. SVD was present in 260 patients (49%), MVD without CTO in 161 patients (30%) and a CTO in a non-IRA in 113 patients (21%). Patients with a CTO had a higher incidence of cardiogenic shock and more often had a history of a previous MI compared to patients with SVD and MVD without CTO. Median follow-up duration was 2.6 years (IQR 1.3–3.5 years). Kaplan-Meier estimates for five-year mortality were 16% in the SVD group, 18% in the MVD group and 45% in the CTO group (Figure 1⇓). After multivariate analysis, a CTO in a non-IRA was an independent predictor of mortality (HR 2.1, 95%CI 1.4 –3.1, p<0.01). Other independent predictors were shock (HR 4.3) and age above 60 years (HR 1.7).
Conclusion: A CTO in a non-IRA, and not MVD without a CTO, is a strong and independent predictor of long-term mortality in STEMI patients with diabetes.