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Incidence and clinical impact of concurrent chronic total occlusion according to gender in ST‐Elevation myocardial infarction
Author(s) -
Bataille Yoann,
Déry JeanPierre,
Larose Éric,
Abdelaal Eltigani,
Machaalany Jimmy,
RodésCabau Josep,
Rinfret Stéphane,
Déry Ugo,
Costerousse Olivier,
Roy Louis,
Bertrand Olivier F.
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24697
Subject(s) - medicine , incidence (geometry) , myocardial infarction , cardiology , mortality rate , optics , physics
Objectives To determine the prevalence of a concurrent CTO in men and women and to examine its impact on mortality. Background The impact of chronic total occlusion (CTO) in patients with ST‐elevation myocardial infarction (STEMI) according to gender has not been assessed. Methods Patients referred with STEMI were categorized into single vessel disease (SVD), multivessel disease (MVD) without, with 1 or > 1 CTO. The primary end‐point was the 1‐year mortality. Results Among the 2020 STEMI patients included between 2006 and 2011, 24% were female. Women were older, had more hypertension and renal failure ( P < 0.0001 for all). The prevalence of 1 or > 1 concurrent CTO was similar in both sexes, 7 and 1%, respectively. Early and late mortality was significantly higher in women compared with men ( P < 0.0001). In women, the mortality was significantly worse in patients with > 1 CTO (100%) and with 1 CTO (36.4%) compared with those with MVD without CTO (18.4%) or with SVD (10.4%) ( P < 0.0001). MVD with and without concurrent CTO were both independent predictors of 1‐year mortality in women (HR 3.58; 95 % CI 1.69–7.18 and HR 2.76; 95 % CI 1.33–5.51) whereas only MVD with CTO was predictive in men (HR 2.19; 95% CI 1.20–3.97). Conclusions Among unselected STEMI patients, the prevalence of CTO was equal in both sexes whereas early and late mortality remained significantly higher in women. Other factors than the presence of a concurrent CTO must be explored to explain differences in survival after STEMI between women and men. © 2013 Wiley Periodicals, Inc.