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The Korean chronic total occlusion (CTO) registry was collected by retrospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesion in acute myocardial infarction (AMI) patients on clinical outcomes.
Among 2,813 patients who underwent a staged PCI due to CTO lesions, a total of 422 patients (15%) underwent primary PCI due to AMI. Among 422 patients, successful percentage of a staged CTO-PCI was 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust the baseline confounders, a propensity score matched analysis was performed (C-statics: 0.731), and 170 patients were finally enrolled.
The incidence of total death (10.5% vs 2.3%, p=0.029) and Non ST elevation MI (NSTEMI, 4.7% vs 0%, p=0.043) at one year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing for mortality (HR 0.21, 95% CI 0.045 to 0.98, p-value=0.048). Kaplan-Meier curve showed that the successful CTO-PCI had lower cumulative total death (log rank=0.004) and cardiac death (log rank=0.005) up to one year in the of NSTEMI patients. In subgroup analysis, cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEIM, hypertension, and non left anterior descending artery lesion for preventing mortality.
In this study, a staged successful CTO-PCI in AMI patients is associated with improved one year survival in Korean population.