Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (From the PL-ACS Registry)

BackgroundThree-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to assess the impact on 12‐month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease.MethodsThe study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. The patients with prior coronary artery bypass grafting and those with significant stenosis of the left main coronary artery were excluded. The 12-month mortality was obtained from a government database.ResultsOf the 925 patients fulfilling the inclusion and exclusion criteria, 438 (47.4%) patients had 1 or more CTO of a major non-IRA coronary artery (+ CTO), and 487 (52.6%) patients had 3-vessel disease without CTO (− CTO). The in-hospital mortality for the + CTO and − CTO patients was 5.3% and 2.1%, respectively (p = 0.009), whilst the 12-month mortality was 21.1% and 11.9%, respectively (p = 0.0001). After multivariate adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk = 1.42, 95%CI = 1.01-2.00, p = 0.047).ConclusionsThe presence of CTO in non-IRA in patients with NSTEMI and 3‐vessel coronary disease predicts higher 12-month mortality.