Introduction:

the presence of chronic total occlusions (CTOs) is frequently observed in cases referring to coronary angiography. CTOs are associated with multivessel disease. Several studies have shown that the presence of CTOs is a predictor of early and late mortality and is even a poor prognostic factor in cases of ST elevation myocardial infarction (STEMI).

Objective:

to determine differences in all-cause mortality at 30 days and 3 years in subjects with STEMI who did or did not present at least one CTO in a non-infarction related artery (non-IRA).

Methods:

observational, analytical, retrospective, single-center case-control study. We included cases of ST-segment elevation acute coronary syndrome (STE-ACS) treated with primary angioplasty at our center between 2013 and 2018. The CTO group included cases with a non-IRA CTO, defined as the presence of TIMI 0 flow in the occluded coronary segment, with an estimated occlusion time greater than 3 months. The control group was selected by 2:1 matching of the total STE-ACS with age and sex as matching criteria. Continuous variables are presented as mean ± SD, and discrete variables are presented as absolute values and percentages. Alpha error < 0.05 was set. Kaplan-Meier survival curves and log-rank tests were used to establish differences in survival. Odds ratios (OR) and 95% confidence intervals were calculated. A multivariate logistic regression model was performed to eliminate confounding variables (adjusted OR).

Results:

of a total of 1,520 STEMI, 135 cases and 270 controls were included. The median time between ACS and registration (follow-up) was 5.4 years (IQ 3.4-6.9 years). During this period, 56 deaths were observed in the CTO group (41.5%; CI 33.2-49.8%), and 59 deaths in the control group (21.9%; CI 14.9-28.9%), p < 0.001. The OR for death at the end of the period was 2.535 (CI 1.620-3.967), and the OR for death at the end of the adjusted period was 1.407 (CI 1.231-1.719). The 30-day mortality rate was 22.2% (CI 15.2-29.2%) and 11.2% (CI 7.4-15.0%) for the CTO and control groups, respectively; p = 0.003, OR at month: 2,286 (CI 1,311-3,984). The 3-year mortality rate for the CTO group was 32.6% (CI 24.7-40.5%), being lower for the control group at 15.9% (CI 11.5-20.3%), p < 0.001; 3-year OR: 2,553 (95% CI 1,571-4,148).

Conclusions:

having a non-ARI CTO doubles the 30-day and 3-year mortality rates after the index event compared with the group without such lesions. The presence of a CTO is an independent predictor of higher mortality in the multivariate analysis.

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