A comparison of long-term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct-related artery after PCI of acute myocardial infarction.

Abstract

BACKGROUND:

Chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI.

METHODS:

We retrospectively enrolled 330 patients (successful CTO PCI in 166 patients, failed CTO PCI in 32 patients, MT in 132 patients) with non-IRA CTO from a total of 4372 patients who underwent PCI after AMI in our center. Propensity score matching (PSM) was used to adjust for baseline differences.

RESULTS:

The primary analysis is based on the intention-to-treat population. During a median follow-up period of 946 days, patients in the PCI group (n = 198) had significantly higher cardiac death-free survival (96.6% vs. 82.8%, p = .004) compared with patients in MT group (n = 132). However, no significant difference in the occurrence of cardiac death was observed after PSM. The analysis based on the per-protocol population demonstrated significantly higher cardiac death-free survival in the successful CTO PCI group (n = 166) compared with the occluded CTO group (n = 164) both before and after PSM. In subgroup analysis, successful CTO PCI was associated with less cardiac death in patients over 65 years old, with LVEF < 50%, left anterior descending (LAD) IRA, and non-LAD CTO lesion compared with occluded CTO group.

CONCLUSIONS:

Patients undergoing successful revascularization of non-IRA CTO after AMI might have a better long-term prognosis. Moreover, patients with LVEF < 50% may benefit from successful non-IRA CTO PCI after AMI.

• Authors: Qing Qin, Lu Chen, Lei Ge, Juying Qian, Jianying Ma, Junbo Ge
• Journal: Clinical cardiology (Clin Cardiol) Vol. 45 Issue 1 Pg. 136-144 (Jan 2022) ISSN: 1932-8737 [Electronic] United States
• PMID: 34989416 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Topics

• Aged
• Arteries
• Chronic Disease
• Coronary Occlusion (diagnosis, surgery)
• Humans
• Myocardial Infarction (therapy)
• Percutaneous Coronary Intervention (adverse effects)
• Retrospective Studies
• Risk Factors
• Treatment Outcome