Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial
Top Cited Papers
Open Access
- 12 January 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 33 (6), 768-775
- https://doi.org/10.1093/eurheartj/ehr471
Abstract
We sought to investigate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) on mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In the HORIZONS-AMI trial, of 3283 patients undergoing primary PCI, 1524 patients (46.4%) had single-vessel disease (SVD), 1477 (45.0%) had MVD without a CTO, and 283 (8.6%) had MVD with a CTO in a non-IRA. Compared with SVD patients and MVD patients without a CTO, patients with a non-IRA CTO were significantly less likely to achieve post-procedural TIMI 3 flow (P = 0.0003), more often had absent myocardial blush (P = 0.0002), and less frequently achieved complete ST-segment resolution (P = 0.0001). By multivariable analysis, MVD with CTO in a non-IRA was an independent predictor of both 0- to 30-day mortality [hazard ratio (HR) 2.88, 95% confidence interval (CI) 1.41–5.88, P = 0.004] and 30-day to 3-year mortality (HR 1.98, 95% CI 1.19–3.29, P= 0.009), while MVD without a CTO was a significant predictor for 0- to 30-day mortality (HR 2.20, 95% CI 1.00–3.06, P = 0.049) but not late mortality. In patients with STEMI undergoing primary PCI in the HORIZONS-AMI trial, MVD with or without a CTO in a non-IRA was an independent predictor of early mortality. The presence of a CTO in a non-IRA was also an independent predictor of increased late mortality to 3 years.Keywords
This publication has 22 references indexed in Scilit:
- Impact of chronic total occlusions on markers of reperfusion, infarct size, and long‐term mortality: A substudy from the TAPAS‐trialCatheterization and Cardiovascular Interventions, 2011
- Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarctionHeart, 2010
- Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary InterventionJACC: Cardiovascular Interventions, 2009
- Paclitaxel-Eluting Stents versus Bare-Metal Stents in Acute Myocardial InfarctionThe New England Journal of Medicine, 2009
- The Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial: Study design and rationaleAmerican Heart Journal, 2008
- Bivalirudin during Primary PCI in Acute Myocardial InfarctionThe New England Journal of Medicine, 2008
- Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapyHeart, 2006
- Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trialsThe Lancet, 2003
- Selection of reperfusion therapy for individual patients with evolving myocardial infarctionEuropean Heart Journal, 1997
- Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi.Heart, 1976