Author + information
- Mohammed Saad1,
- Georg Fuernau2,
- Steffen Desch3,
- Ingo Eitel1,
- Suzanne de Waha2,
- Janine Pöss2 and
- Holger Thiele4
The presence of a CTO is reported to be associated with worse prognosis in patients with CS complicating AMI.
In a sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) and its accompanying registry, patients were divided according to the presence or absence of a CTO in a non-IRA.
In total, 201 (26%) of 761 patients had a CTO in a non-IRA major coronary artery. Patients with a CTO had a significantly higher incidence of 3-vessel coronary artery disease and lower left ventricular ejection fraction. Mortality was significantly higher in the CTO group at day of admission, 30 days, 6 and 12 months. At 30-day follow-up, patients with CTO suffered more ventricular arrhythmias requiring defibrillation (33% vs. 21%, odds ratio [OR] 1.83, 95% confidence interval [CI] 1.28-2.62, p<0.001). The OR for ventricular fibrillation was 1.51, 95% CI 1.01-2.25, p=0.04 and for ventricular flutter 2.22, 95% CI 1.23-4.0, p=0.007, respectively. In the adjusted multivariate Cox regression analysis, a CTO in a non-IRA was an independent predictor of mortality at 12 months (hazard ratio 1.30, 95% CI 1.02–1.67, p=0.03).
|CTO in a non-IRA||1.30||1.02-1.67||0.03|
|Age, per 10 years||1.29||1.17-1.43||<0.001|
|History of stroke||1.78||1.24-2.55||0.002|
|Peripheral vascular disease||1.43||1.08-1.90||0.01|
|Baseline creatinine, per 100 μmol/L||1.19||1.10-1.28||<0.001|
|Baseline arterial lactate, per 5 mmol/L||1.17||1.12-1.22||<0.001|
|TIMI flow <3 after PCI||1.93||1.49-2.49||<0.001|
The presence of CTO in a non–IRA is associated with a higher incidence of ventricular arrhythmias in patients with CS complicating AMI and is an independent predictor of mortality.
CORONARY: Acute Myocardial Infarction