Abstract 12682: Chronic Total Occlusion in a Non-Infarct Coronary Artery Exacerbates Prognosis of the Patients With Acute Myocardial Infarction
Introduction: Several observational studies suggested that co-existence of the significant stenosis in the non-infarct related coronary artery worsened clinical outcome of the patient with acute myocardial infarction (AMI). However, there is a paucity of data regarding the impact of chronic total occlusion (CTO) in non-infarct coronary artery on prognosis in patients with AMI.
Methods: We retrospectively evaluated 429 consecutive patients with AMI who underwent primary percutaneous coronary intervention in our hospital between January 2008 and December 2012. AMI patients complicated with cardiopulmonary arrest out of the hospital, having the left main trunk culprit lesion, and diagnosed after 24 hours from the symptoms onset were excluded.
Results: Of those, 41 (9.6%) patients had CTO lesions in a non-infarct related artery (CTO patients). Those patients were significantly more likely to be associated with cardiogenic shock (30.2% vs 11.6%; p<0.01) and to require an extracorporeal membrane oxygenator (ECMO) because of cardiopulmonary arrest in the emergency department or catheterization laboratory (12.2% vs 2.3%; p<0.001) when compared with patients without CTO lesion (non CTO patients). Intraaortic balloon pumping also is also required in 28 (68.3%) CTO patients. Despite peak creatinine kinase level between 2 groups was similar (2815 U/L vs 2116 U/L), the left ventricular ejection fraction estimated by echocardiography after primary PCI was significantly lower in CTO patients as compared with non CTO patients (45.3% vs 54.8%; p<0.0001). The in-hospital mortality and 30-days mortality were significantly higher in CTO patients as compared with non CTO patients (19.5% vs 4.6%; p<0.0001, 14.6% vs 3.4%; p<0.001, respectively).
Conclusions: AMI patients associated with CTO lesions required more frequent use of assist devices and had significantly poor outcome as compared with those without CTO lesion.
Author Disclosures: Y. Mizuguchi: None. A. Takahashi: None. T. Yamada: None. N. Taniguchi: None. S. Nakajima: None. T. Hata: None.
- © 2014 by American Heart Association, Inc.