Procedural and In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction: Insights From a Prospective Multicenter International Registry

Pouyan Arman, Mir B. Basir, Ankur Gupta, James W. Choi, Jaikirshan J. Khatri, Farouc A. Jaffer, Paul Poomipanit, Farshad Forouzandeh, Michalis Koutouzis, Ioannis Tsiafoutis, Mitul Patel, Ehtisham Mahmud, Evangelia Vemmou, Ilias Nikolakopoulos, Judit Karacsonyi, Ahmed ElGuindy, Omer Goktekin, Nidal Abi Rafeh, Emmanouil S. Brilakis, Khaldoon Alaswad

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We sought to examine the procedural and clinical outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI). METHODS: We assessed the clinical and procedural characteristics, technical success, procedural success, and in-hospital outcomes of 2314 patients who underwent CTO-PCI at 20 experienced centers between 2012 and 2017, classified according to whether or not they presented with AMI. RESULTS: Mean patient age was 65 ± 10 years, 85% were men, and 154 (6.7%) presented with AMI (5.5% with non-ST segment elevation myocardial infarction, 1.1% with ST-segment elevation myocardial infarction). Compared with non-AMI patients who underwent CTO-PCI, AMI patients had higher prevalence of diabetes (56% vs 42%; P<.01) and lower median left ventricular ejection fraction (48% vs 54%; P<.001). The CTO angiographic characteristics were similar between the 2 groups. Compared with non-AMI patients undergoing CTO-PCI, AMI patients had more frequent use of antegrade wire escalation (86.0% vs 78.9%; P=.03) and more frequent use of hemodynamic support devices (16.2% vs 3.4%; P<.01), and were more likely to have a non-CTO lesion treated (34.0% vs 26.6%; P=.03). AMI and non-AMI patients had similar technical success (90% vs 87%; P=.26), procedural success (88% vs 85%; P=.38), and incidence of in-hospital MACE (2.6% vs 2.5%; P=.94). CONCLUSION: CTO-PCI is performed infrequently in AMI patients and is associated with similar technical and procedural success rates and in-hospital major adverse cardiovascular event rates when compared with CTO-PCI performed in non-AMI patients.

Original languageEnglish (US)
Pages (from-to)E670-E676
JournalThe Journal of invasive cardiology
Volume33
Issue number9
StatePublished - Sep 1 2021

Keywords

  • acute myocardial infarction
  • chronic total occlusion (CTO)
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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