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Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention

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Abstract

Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17–0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.

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Acknowledgements

The authors thank Dr. Tatami for his help collect patient’s data.

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Authors and Affiliations

  1. Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan

    Ruka Yoshida, Akihito Tanaka, Hiroshi Tashiro, Kiyoshi Niwa & Kenji Furusawa

  2. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan

    Ruka Yoshida, Itsuro Morishima, Kensuke Takagi, Naoki Yoshioka, Yasuhiro Morita & Hideyuki Tsuboi

  3. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Hideki Ishii, Takashi Kataoka, Yusuke Hitora & Toyoaki Murohara

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  1. Ruka Yoshida
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Correspondence to Ruka Yoshida.

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Conflict of interest

Department of Cardiology, Nagoya University Graduate School of Medicine received research Grant from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd. H. Ishii. received lecture fees from Astellas Pharma Inc., Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharma Inc., and MSD K. K. T. Murohara received lecture fees from Bayer Yakuhin., Ltd., Daiichi-Sankyo Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd. Other authors declare that they have no conflict of interest.

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12928_2019_615_MOESM1_ESM.pptx

The cause of all-cause mortality between the successfully recanalized chronic total occlusion (SR-CTO), and no recanalized CTO (NR-CTO) groups. Panels A and B shows the details of the all-cause mortality in patients who were classified into the SR-CTO-PCI, and NR-CTO groups. CHF, congestive heart failure; CAD, coronary artery disease; SCD, sudden cardiac death. (PPTX 72 kb)

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Yoshida, R., Ishii, H., Morishima, I. et al. Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention. Cardiovasc Interv and Ther 35, 259–268 (2020). https://doi.org/10.1007/s12928-019-00615-8

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