Premium
The impact of multivessel disease with and without a co‐existing chronic total occlusion on short‐ and long‐term mortality in ST‐elevation myocardial infarction patients with and without cardiogenic shock
Author(s) -
Hoebers Loes P.,
Vis Marije M.,
Claessen Bimmer E.,
Schaaf René J.,
Kikkert Wouter J.,
Baan Jan,
Winter Robbert J.,
Piek Jan J.,
Tijssen Jan G.P.,
Dangas George D.,
Henriques José P.S.
Publication year - 2013
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs182
Subject(s) - medicine , cardiogenic shock , cardiology , myocardial infarction , percutaneous coronary intervention , hazard ratio , coronary artery disease , confidence interval
Aims To evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST‐elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS). Methods and results A total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5‐year follow‐up with a landmark set at 30 days. In patients without CS ( n = 4409), only MVD with a CTO was an independent predictor for 30‐day [hazard ratio (HR) 2.8, P < 0.01] and 5‐year mortality (HR 1.7, P < 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients ( n = 609), MVD with and without a CTO were independent predictors for 30‐day mortality (HR 2.2, P < 0.01 and HR 1.8, P < 0.01). In 30‐day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P = 0.06). Conclusion In non‐CS STEMI patients with MVD, the presence of a co‐existing CTO in a non‐infarct‐related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short‐term mortality.