The short-term and long-term prognostic analysis in patients with chronic total occlusion acute non-ST segment elevation myocardial infarction
10.3760/cma.j.cn112138-20210626-00445
- VernacularTitle:慢性闭塞病变合并急性非ST段抬高型心肌梗死的近远期预后分析
- Author:
Tianjie WANG
1
;
Junle DONG
;
Sen YAN
;
Guihao CHEN
;
Ge CHEN
;
Yanyan ZHAO
;
Haiyan QIAN
;
Jiansong YUAN
;
Lei SONG
;
Shubin QIAO
;
Jingang YANG
;
Weixian YANG
;
Yuejin YANG
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院冠心病中心，北京 100037
- Keywords:
Myocardial infarction;
Acute;
Myocardial revascularization;
Chronic total occlusion;
Prognosis
- From:
Chinese Journal of Internal Medicine
2022;61(4):384-389
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI).Methods:A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding.Results:Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( HR 7.28, 95% CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age ( HR 1.04, 95% CI 1.01-1.07, P<0.01), and low levels of ejection fraction ( HR 0.95, 95% CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO ( HR1.67, 95% CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions:Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.
