Ji Young Park1, Byoung Geol Choi2, Seung-Woon Rha3, Tae Soo Kang4, Cheol Ung Choi3, Cheol Woong Yu5, Hyeon-Cheol Gwon6, In-Ho Chae7, Hyo-Soo Kim8, Hun Sik Park9, Seung-Hwan Lee10, Moo-Hyun Kim11, Seung-Ho Hur12, Yangsoo Jang13. 1. Department of Internal Medicine, Division of Cardiology, Eulji Hospital, Eulji University. 2. Department of Internal Medicine, Division of Cardiology, Korea University Graduate School. 3. Department of Internal Medicine, Division of Cardiology, Korea University Guro Hospital. 4. Department of Internal Medicine, Division of Cardiology, Dankook University Hospital, Cheonan. 5. Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital. 6. Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine. 7. Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Bundang. 8. Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital. 9. Department of Internal Medicine, Division of Cardiology, Kyungpook National University Hospital. 10. Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju. 11. Department of Internal Medicine, Division of Cardiology, Dong-A University Hospital, Busan, Korea. 12. Keimyung University Dongsan Medical Center, Daegu. 13. Department of Internal Medicine, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul.
Abstract
BACKGROUND: The Korean chronic total occlusion (CTO) registry was collected prospectively 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 lesions in acute myocardial infarction (AMI) patients on clinical outcomes. PATIENTS AND METHODS: Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model. RESULTS: After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality. CONCLUSION: In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.
BACKGROUND: The Korean chronic total occlusion (CTO) registry was collected prospectively 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 lesions in acute myocardial infarction (AMI) patients on clinical outcomes. PATIENTS AND METHODS: Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model. RESULTS: After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality. CONCLUSION: In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.
Authors: Eleonora Melotti; Marta Belmonte; Carlo Gigante; Vincenzo Mallia; Saima Mushtaq; Edoardo Conte; Danilo Neglia; Gianluca Pontone; Carlos Collet; Jeroen Sonck; Luca Grancini; Antonio L Bartorelli; Daniele Andreini Journal: Front Cardiovasc Med Date: 2022-05-02