Abstract 16390: Impact of Revascularization of Chronic Total Occlusion in Patients With and Without Acute Myocardial Infarction
Introduction: Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) has been a major challenge due to technical difficulties with increased complication rates. Approximately 10-15% of patients with acute myocardial infarction (AMI) have CTO. There is limited data comparing the impact of AMI in patients with CTO.
Hypothesis: We aimed to perform a trend analysis from a national registry comparing outcomes of PCI of CTO in patients with and without AMI.
Methods: All patients with a diagnosis of CTO were identified from National Inpatient Sample (NIS) 2007-2010 database using 9th revision of International Classification of Diseases (ICD) code 414.2. Patients with a primary diagnosis of ST-segment elevation AMI were extracted using ICD 9 code 410.x1 and only patients who underwent PCI were included. Differences in demographic and traditional risk factors were studied between the 2 groups. Primary outcomes of interest were in-hospital mortality, cardiac arrest and development of acute kidney injury (AKI).
Results: From 2007 to 2010, CTO was identified in 382,883 patients, among which 138,948 (36%) patients had AMI as primary diagnosis. Mean age was 66.3±0.1 years and 28% were females. There was a trend in increased prevalence of all traditional risk factors in patients with CTO and without AMI. However, length of stay (4.9±0.03 vs 4.3±0.02), in-hospital mortality (4% vs 1.5%), cardiac arrest (3.5% vs 1.2%) and prevalence of AKI (10.1% vs 7.5%) were significantly increased in patients with CTO and AMI (p<0.0001). The presence of AMI in CTO predicted more AKI after PCI even after adjusting for all risk factors [OR 1.66 (156-1.76); p=0.000].
Conclusions: Presence of AMI in patients with CTO was associated with poor clinical outcomes including in-hospital mortality, cardiac arrest, prolonged hospital stay, and development of AKI. Additional studies are needed to further corroborate these findings.
- Acute coronary syndromes
- Myocardial infarction, STEMI
- Percutaneous coronary intervention (PCI)
Author Disclosures: P. Krishnamoorthy: None. A. Gopalakrishnan: None. J. Garg: None. J. Rangaswami: None. V. Bhalla: None. C.F. Witzke: None. S. Janzer: None. D.L. Morris: None. J. George: None.
- © 2016 by American Heart Association, Inc.