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- Title
The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction.
- Authors
Teng, Hsin‐I; Sung, Shih‐Hsien; Huang, Shao‐Sung; Pan, Ju‐Pin; Lin, Shing‐Jong; Chan, Wan‐Leong; Lee, Wen‐Lieng; Lu, Tse‐Min; Wu, Cheng‐Hsueh; Teng, Hsin-I; Sung, Shih-Hsien; Huang, Shao-Sung; Pan, Ju-Pin; Lin, Shing-Jong; Chan, Wan-Leong; Lee, Wen-Lieng; Lu, Tse-Min; Wu, Cheng-Hsueh
- Abstract
<bold>Objectives: </bold>The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI).<bold>Background: </bold>CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting.<bold>Methods: </bold>Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group).<bold>Results: </bold>The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007).<bold>Conclusions: </bold>Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
- Subjects
PERCUTANEOUS coronary intervention; CORONARY disease; REVASCULARIZATION (Surgery); MYOCARDIAL revascularization; CARDIAC surgery
- Publication
Journal of Interventional Cardiology, 2018, Vol 31, Issue 3, p302
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1111/joic.12501