Meta-Analysis of the Impact on Mortality of Noninfarct-Related Artery Coronary Chronic Total Occlusion in Patients Presenting With ST-Segment Elevation Myocardial Infarction

• Published in: The American journal of cardiology Vol. 116; no. 1; pp. 8 - 14
• Main Authors: O'Connor, Stephen A., MB, MD, Garot, Philippe, MD, Sanguineti, Francesca, MD, Hoebers, Loes P., MD, Unterseeh, Thierry, MD, Benamer, Hakim, MD, Chevalier, Bernard, MD, Hovasse, Thomas, MD, Morice, Marie-Claude, MD, Lefèvre, Thierry, MD, Louvard, Yves, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2015; Elsevier Limited
• Subjects: Cardiology; Cardiovascular; Chronic Disease; Confidence intervals; Coronary Occlusion - mortality; Coronary Occlusion - therapy; Electrocardiography; Epidemiology; Evidence-Based Medicine; Heart attacks; Heart Conduction System - physiopathology; Humans; Incidence; Medical prognosis; Meta-analysis; Mortality; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Percutaneous Coronary Intervention - methods; Prognosis; Randomized Controlled Trials as Topic; Studies; Time Factors; United States - epidemiology; Veins & arteries; United States
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.03.031

Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis evaluating the impact of the presence of an n-IRA CTO on short- and long-term mortality after primary percutaneous coronary intervention. Studies published from January 1980 to January 2014 that compared the incidence of all-cause mortality in patients with ST-segment elevation myocardial infarction with co-existing n-IRA CTO versus those without were identified using an electronic search and reviewed using meta-analytical techniques. Seven studies (5 observational studies and 2 observational analyses of randomized controlled trials) comprising 14,117 patients and 1,554 patients (11.7%) with n-IRA CTO were included. The presence of n-IRA CTO was associated with increased incidence of all-cause mortality at a median follow-up of 25.2 months (interquartile range 24 to 60) compared with no CTO (absolute risk 23.5% vs 9.0%; odds ratio [OR] 2.90, 95% confidence interval [CI] 2.09 to 4.01; p <0.0001). This finding was consistent in the analysis of studies reporting 30-day follow-up (absolute risk 17.2% vs 4.7%; OR 3.79, 95% CI 3.13 to 4.59; p <0.0001). Co-existing n-IRA CTO was also associated with increased mortality in a subanalysis of patients with multivessel disease only (absolute risk 24.2% vs 11.3%; OR 2.23, 95% CI 1.90 to 2.63; p <0.0001). In conclusion, coronary CTO in the nonculprit artery in patients presenting with ST-segment elevation myocardial infarction is associated with increased short- and long-term all-cause mortality.