The impact of successful revascularization of coronary chronic total occlusions on long‐term clinical outcomes in patients with non‐ST‐segment elevation myocardial infarction |
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| Authors: | Hsin‐I Teng MD Shih‐Hsien Sung MD Shao‐Sung Huang MD Ju‐Pin Pan MD Shing‐Jong Lin MD Wan‐Leong Chan MD Wen‐Lieng Lee MD Tse‐Min Lu MD Cheng‐Hsueh Wu MD |
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| Affiliation: | 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;2. Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang‐Ming University, Taipei, Taiwan;3. Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan;4. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan;5. Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan;6. Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan |
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| Abstract: | Objectives The purpose of this study was to assess the long‐term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non‐ST‐segment elevation myocardial infarction (NSTEMI). Background CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. Methods Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). Results The 30‐day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30‐day survivals was performed. After a mean of 2.5‐year follow‐up, the long‐term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long‐term cardiac death (HR 0.310, 95% CI, 0.109‐0.881, P = 0.028) in all population and in propensity‐score matched cohort (P = 0.007). Conclusions Successful revascularization of CTO was associated with reduced risk of long‐term cardiac death in patients with NSTEMI and concomitant CTO. |
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| Keywords: | chronic total occlusion non‐ST segment elevation myocardial infarction |
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