Impact of chronic total occlusions on markers of reperfusion, infarct size, and long‐term mortality: A substudy from the TAPAS‐trial

Abstract

Objectives: This study evaluated the impact of a chronic total occlusion (CTO) in a non‐infarct related coronary artery (IRA) on markers of reperfusion, infarct size, and long‐term cardiac mortality in patients with ST‐elevation myocardial infarction (STEMI). Background: A concurrent CTO in STEMI patients has been associated with impaired left ventricular function and outcome. However, the impact on markers of reperfusion is unknown. Methods: All 1,071 STEMI patients included in the TAPAS‐trial between January 2005 and December 2006 were used for this substudy. Endpoints were the association between a CTO in a non‐IRA and myocardial blush grade (MBG) of the IRA, ST‐segment elevation resolution (STR), enzymatic infarct size, and clinical outcome. Results: A total of 90 patients (8.4%) had a CTO. MBG 0 or 1 occurred more often in the CTO group (34.2% versus 20.6% (Odds Ratio [OR] 2.00, 95% confidence interval [CI]: 1.22–3.23, P = 0.006)). Incomplete STR occurred more often in the CTO group, (63.6% versus 48.2% [OR 1.96, 95% CI: 1.22–3.13, P = 0.005]). Median level of maximal myocardial‐band of creatinin kinase (CK‐MB) in the CTO group was 75 μg/l (IQR 28‐136) and 51 μg/l (IQR 18–97) in the no‐CTO group (P = 0.021). The presence of a CTO in a non‐IRA in STEMI patients was an independent risk factor for cardiac mortality (HR 2.41, 95% CI: 1.26–4.61, P = 0.008) at 25 months follow‐up. Conclusion: A CTO in a non‐IRA is associated with impaired reperfusion markers and impaired long‐term outcome in STEMI patients.