Author + information
- Yukio Mizuguchi,
- Akihiko Takahashi,
- Takeshi Yamada,
- Norimasa Taniguchi,
- Shunsuke Nakajima and
- Tetsuya Hata
Chronic total occlusion (CTO) in the non-infarcted-related artery was reported to worsen immediate clinical outcome in patients with acute myocardial infarction (AMI). However, the prognosis of such patients with preserved left ventricular function has not been clarified yet. Our objectives were to evaluate whether the presence of CTO solely contributes to worsen the prognosis in the patients with well-preserved heart function after primary PCI.
We retrospectively evaluated 353 consecutive AMI patients with preserved left ventricular pump function (left ventricular ejection fraction; LVEF ≥40%) who underwent primary percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. AMI patients complicated with cardiopulmonary arrest out of the hospital (n=33), having the left main trunk culprit lesion (n=23), and diagnosed after 24 hours from the symptoms onset (n=62) were excluded from total study population. The patients required to an extracorporeal membrane oxygenator (ECMO) for hemodynamic support during and after PCI were excluded because LVEF could not be evaluated accurately due to influence on hemodynamics by ECMO.
Of those, 25 (7.0%) patients had CTO lesions in a non-infarct related artery (CTO patients). The LVEF estimated by echocardiography after primary PCI was similar between CTO patients and patients without CTO lesion (non CTO patients) (55.1±8.6% vs 58.0±9.4%; p=0.07). CTO patients were significantly more likely to be associated with cardiogenic shock (24.0% vs 7.6%; p<0.05) and to require intraaortic balloon pumping (56.0% vs 12.5%; p<0.001) compared with non CTO patients. Thirty-days mortality was significantly higher in CTO patients as compared with non CTO patients (12.0% vs 0.9%; p<0.001). By multivariate analysis, 30-days survival as well as cardiogenic shock were independently associated with CTO (odds ratio [OR] 20.42, 95% CI 3.38-123.29, p<0.001, OR 3.99, 95% CI 1.46-10.92, p<0.01, respectively).
In patients with AMI, even if their LVEF were preserved, CTO was strongly associated with cardiogenic shock and high mortality.